儿童结核性脑膜炎的相关问题

结核性脑膜炎 (简称结脑 )是儿童肺外结核病最常见的类型 ,也是最严重的结核病。重庆市儿童医院 1993～ 2 0 0 2年 10年间共收治儿童各类结核病 737例 ,其中结核性脑膜炎为 319例 ,占儿童结核病住院总数 4 3 2 %。在链霉素出现以前 ,结脑的病死率几乎是 10 0 % ,随着近年对结脑的深入研究 ,结脑的诊断和治疗得到空前的发展 ,预后也得到很大的改善。但是 ,在许多地区儿童结脑的误诊、漏诊率仍然很高 ,因此如何不断提高对儿童结脑的认识及诊断水平 ,则成为儿科医务工作者所关注的问题之一。本文就儿童结脑诊断及治疗中容易出现的相关问题进行…     

Cerebrospinal fluid pyrazinamide concentrations in children with tuberculous meningitis

Cerebrospinal fluid pyrazinamide concentrations were determined by high pressure liquid chromatography in 53 samples from 13 children who had tuberculous meningitis complicated by increased intracranial pressure. Peak concentrations of up to 50 micrograms/ml were achieved between 1 1/2 and 2 1/2 hours after pyrazinamide administration and in most cases a concentration of 20 micrograms/ml or more was achieved. We conclude that pyrazinamide easily gains entry into the cerebrospinal fluid of children with tuberculous meningitis and should be included in treatment regimens for that disease.     

Chest computed tomography in children

This article describes the use of computed tomography for the evaluation of pediatric patients with a variety of chest diseases. Indications for chest CT, constraints of technical factors on the study, and analysis of the benefits of CT examination versus risks will also be discussed.     

��ͯ�������Ĥ�׵����ƾ�������

结核性脑膜炎(结脑)治疗的目的是抢救病人生命,防止和减少后遗症的发生,彻底治愈病人,防止复发。其关键在于早期诊断、早期治疗和坚持全程治疗。结脑治疗包括对症支持治疗和抗痨治疗。1对症和支持疗法正确的对症治疗对防止死亡和避免后遗症的发生至关重要。1.1降低颅压,消除脑水肿不论早期或经治疗后的结脑死亡病例,多数系颅压高和(或)脑疝引起。结脑颅压增高持续时间长而且波动大,比如有的患儿上午颅压在1·47kPa(150mmH2O)以下,下午即可超过4·90kPa(500mmH2O),因此勿因一次脑压正常而放松了颅内压的监测和降颅压治疗措施。结脑开始治…     

小儿结核性脑膜炎早期呼吸节律改变

目的探讨结核性脑膜炎(TBM)患儿早期出现呼吸节律改变的机制及其临床意义.方法将34例TBM,59例化脓性脑膜炎,112例中毒性脑炎及102例病毒性脑炎患儿分为4组,进行呼吸节律的临床观察及头颅CT检查,并分析其与病理、预后的相关性.结果4组患儿的呼吸节律改变发生率依次是79.4%,13.5%,11.6%和14.7%;头颅CT脑积水改变的发生率分别是88.2%,15.2%,1.7%和1.9%,各组与TBM比较均P<0.01,TBM的呼吸节律改变及CT改变可出现于病程的早期.结论79.4%的TBM患儿可出现明显的呼吸节律改变,其中55.88%为病程早期,其发生机制除与TBM的病变以脑底明显这一病理改变有关外,主要与其早期出现的脑积水、脑室扩张密切相关.这一临床特征及其CT改变均可作为TBM早期诊断的线索,在与其它脑炎的鉴别诊断上也有重要意义.     

Cerebrospinal fluid concentrations of ethionamide in children with tuberculous meningitis

Cerebrospinal fluid ethionamide concentrations were determined in 18 children (median age 26.5 months) with tuberculous meningitis complicated by raised intracranial pressure. Lumbar spinal fluid specimens were obtained before and after weekly hour-long monitoring of intracranial pressure. Thirty-five paired and four single specimens were evaluated. A dosage schedule of 15 mg/kg was used on 26 occasions, and a spinal fluid ethionamide concentration of 2.5 micrograms/ml, the in vitro minimal inhibitory concentration for Mycobacterium tuberculosis, was exceeded on only seven occasions (27%). A dosage of 20 mg/kg was administered on 13 occasions, and in only two instances (15%) was a concentration of 2.5 micrograms/ml not achieved. Ethionamide in a single daily dosage of 20 mg/kg should be considered for the initial treatment of tuberculous meningitis when the presence of isoniazid-resistant M. tuberculosis cannot be excluded.