结核性脑膜炎诊治的若干问题探讨（附44例报告）

本文总结了４４例结核性脑膜炎（结脑）的诊治经验。提出本病早期误诊，多因缺乏对本病的警惕性。人型ＰＰＤ试验阴性率高达４７．７％，故阴性者亦不能完全排除，滥用氨基糖甙类抗菌素及糖皮质激素，使病情隐蔽增加误诊机会。脑脊液的结核菌ＰＣＲ检查及反复多次进行胸部Ｘ线检查有利于确立诊断，头颅ＣＴ或ＭＲ检查有助于发现脑积水。对结脑的治疗除了控制结核感染外，还要注意防治并发症，对脑梗阻患者行侧脑室持续冲洗置换术治疗可收到良效。

An approach to diagnosis and treatment of tuberculous meningitis:A clinical analysis of 44 cases

The experience in the diagnosis and treatment of 44 cases of tuberculous meningitis was summarized in this paper. The lack of alterness to the tuberculosis was one of the main causes of the misdiagnosis. If the skin test of human PPD appeare negative, it can not exclude the tuberculosis because the negative rate was as high as 47.7% in this group The abusive use of aminosaccharide antibiotics and corticosteroids might conceale the clinical mainfestation and increase the misdiagnosis rate. Detection of TB DAN by PCR in CSF and pneumonograph are helpful to the diagnosis. The CT or MRI scan of head may reveal the hydrocephalus. Besides the chemotherapy of antituberculous drug, the prevention and,treatment of obstractive hydrocephalus and its sequela must be payed more attentions. A good result was obtained in a patient with obstructive hydrocephalus treated by continuous washing of the lateral ventricle in this group.