小儿再发性化脓性脑膜炎28例分析

目的探讨小儿再发性化脓性脑膜炎(以下简称再发化脑)可能的病因及相应治疗对策。方法回顾分析1995—2004年在天津市儿童医院神经科住院的28例再发化脑患儿的临床资料,以及根据可能病因分别行头MR、脊髓MR、颞骨CT、脑干电测听、血IG和血培养等检查。结果28例再发化脑的病因:脑脊液鼻漏13例、脑脊液耳漏8例、脑脊液耳鼻漏1例、潜毛窦5例、体液免疫缺陷病1例。给予急性期抗感染治疗,恢复期根据病情分别给予脑脊液鼻漏修补术,脑脊液耳漏、脑脊液耳鼻漏、内耳修补术,潜毛窦切除术,随诊6个月至2年未再复发。结论化脑是中枢神经系统严重感染性疾病,重者可危及生命。首发化脑就应注意寻找病因,再发化脑更应积极寻找病因并祛除病因,防止再发。

Analysis of 28 cases of recurrent purulent meningitis in children

Objective To study the underlying illnesses and treatments of recurrent purulent meningitis in children.Methods The clinical data of 28 children with recurrent purulent meningitis in Neurology Department of Tianjin Children's Hospital from 1995 to 2004 were analyzed retrospectively.Base on the above underlying illness,the following examinations were done respectively:Head MR,Spinal Core MR,Temporal bone CT,BERA(Brainstem Electric Response Audiometry),Blood IG,Blood cultures,etc.Results The underlying illnesses were identified and classified as cerebrospinal rhinorrhea (13 cases),cerebrospinal fluid otorrhea(8 cases),cerebrospinal fluid leakage(1 case),pilonidal sinus(5 cases),humoral immunity deficiency(1 case).The anti-infection treatments were used in the acute-phase,and then cerebrospinal fluid rhinorrhea repair,CSF otorrhea,cerebrospinal fluid leakage,repair of the inner ear,pilonidal sinus resection were treated respectively in the restoration-phase; and it revealed no recurrence up to 6 months or 2 years follow-up.Conclusion The purulent meningitis is a serious infectious disease of the central nervous system,even life-threatening.Probing the underlying illness is important for the first onset of purulent meningitis,especially for recurrence,and then treatments are given respectively to avoid recurrence.