CAJ | 학술논문

目的：对老年结核性脑膜炎(TBM)的临床特征、治疗效果及预后进行回顾性分析，以利于早期诊断及治疗。方法：对老年TBM和中青年TBM各84例，从入院前确诊率、症体特征、辅助检查异常情况及治疗转归方面进行回顾分析，找出老年 TBM 特点。结果：老年 TBM 和中青年 TBM 患者相比，确诊时间老年组(45±35)天，中青年组(20±15)天，老年组就诊前误诊率高于中青年组，差异有统计学意义(P＜0.05)；老年组高热患者明显少于中青年组，中低热患者明显高于中青年组(P＜0.01)，有非常显著性差异；老年组头痛、视力下降患者少于中青年组，差异有统计学意义(P＜0.05)；老年组脑压升高患者少于中青年组，差异有统计学意义(P＜0.05)；老年组死亡率高于中青年组，差异有统计学意义(P＜0.05)。结论：老年 TBM 患者症状不典型，导致入院前诊断时间长，误诊率和死亡率高；对疑似患者应及时反复腰穿行脑脊液检查及头部CT、MRI检查，做到早期诊断，早期治疗，提高治愈率及降低死亡率。
목적：대노년결핵성뇌막염(TBM)적림상특정、치료효과급예후진행회고성분석，이리우조기진단급치료。방법：대노년TBM화중청년TBM각84례，종입원전학진솔、증체특정、보조검사이상정황급치료전귀방면진행회고분석，조출노년 TBM 특점。결과：노년 TBM 화중청년 TBM 환자상비，학진시간노년조(45±35)천，중청년조(20±15)천，노년조취진전오진솔고우중청년조，차이유통계학의의(P＜0.05)；노년조고열환자명현소우중청년조，중저열환자명현고우중청년조(P＜0.01)，유비상현저성차이；노년조두통、시력하강환자소우중청년조，차이유통계학의의(P＜0.05)；노년조뇌압승고환자소우중청년조，차이유통계학의의(P＜0.05)；노년조사망솔고우중청년조，차이유통계학의의(P＜0.05)。결론：노년 TBM 환자증상불전형，도치입원전진단시간장，오진솔화사망솔고；대의사환자응급시반복요천행뇌척액검사급두부CT、MRI검사，주도조기진단，조기치료，제고치유솔급강저사망솔。
Objective:To retrospectively analyzed the clinical features,therapeutic effect and prognosis of the elderly tuberculous meningitis(TBM),in order to facilitate the early diagnosis and treatment.Methods:We chose the old TBM patients and young TBM patients with 84 cases in each.We retrospectively analyzed the pre hospital diagnosis rate,disease characteristics,abnormal conditions of auxiliary examination and treatment and prognosis of them,in order to find out the characteristics of aged TBM. Results:We compared the old TBM with young TBM,the diagnosed time:the old age group was(45 ± 35)days,the young group was(20 ± 15)days,the misdiagnosis rate of old age group was higher than that in the young group,there was significant difference(P<0.05);high fever patients in the older group was significantly less than that in the young group,low fever patients in the older group was higher than that in the young group(P<0.01),there were very significant differences;In the older group,the patients with headache and decreased visual acuity was significantly less than that in the young group,there was significant difference(P<0.05);In the older group,increased intracranial pressure patients was less than that in the young group,there was significant difference(P<0.05);In the older group,mortality was higher than that in the young group,there was significant difference(P<0.05).Conclusion:The symptoms of elderly patients with TBM are not typical,which result in long diagnosis time pre hospital,the misdiagnosis rate and mortality are high.For the suspected patients,we should carry out lumbar puncture timely for cerebrospinal fluid examination and head CT,MRI examination.We should make early diagnosis,early treatment in order to improve the cure rate and decrease mortality.