CAJ | 학술논문

目的：探讨以化脓性脑膜炎为首发表现的川崎病的临床诊断及治疗。方法选取我院收治的以化脓性脑膜炎为首发表现的川崎病患者32例为研究对象，对其临床资料进行回顾性分析。结果患者治疗前脑脊液检查白细胞、蛋白、氯化物均高于正常值，治疗后则显著降低；外周血检查结果显示CRP、ESR及血小板等治疗后较治疗前显著降低（P＜0.05）；钠、钾、氯化物治疗前后结果变化不大（ P＞0.05）。给予抗生素和丙种球蛋白治疗，治愈24例，好转6例，转外科2例，无死亡，治愈率75％。随访3个月29例患者预后良好，智力正常，2例出现智力低下症状，1例出现轻度肢体活动障碍，治愈率占90.6％。治疗前脑脊液外观浑浊23例，球蛋白阳性27例，治疗后患者情况得到显著改善，CSF浑浊及球蛋白阳性比例显著降低（P＜0.05）。结论以化脓性脑膜炎为首发表现的川崎病治疗应结合临床表现，同时行脑脊液检测、头颅CT 及心电图观察，并合理采用抗生素及丙种球蛋白等药物治疗，可有效提高诊断率，增加治愈率，降低后遗症等不良反应的发生。
목적：탐토이화농성뇌막염위수발표현적천기병적림상진단급치료。방법선취아원수치적이화농성뇌막염위수발표현적천기병환자32례위연구대상，대기림상자료진행회고성분석。결과환자치료전뇌척액검사백세포、단백、록화물균고우정상치，치료후칙현저강저；외주혈검사결과현시CRP、ESR급혈소판등치료후교치료전현저강저（P＜0.05）；납、갑、록화물치료전후결과변화불대（ P＞0.05）。급여항생소화병충구단백치료，치유24례，호전6례，전외과2례，무사망，치유솔75％。수방3개월29례환자예후량호，지력정상，2례출현지력저하증상，1례출현경도지체활동장애，치유솔점90.6％。치료전뇌척액외관혼탁23례，구단백양성27례，치료후환자정황득도현저개선，CSF혼탁급구단백양성비례현저강저（P＜0.05）。결론이화농성뇌막염위수발표현적천기병치료응결합림상표현，동시행뇌척액검측、두로CT 급심전도관찰，병합리채용항생소급병충구단백등약물치료，가유효제고진단솔，증가치유솔，강저후유증등불량반응적발생。
Objective To explore clinical diagnosis and treatment of Kawasaki disease with purulent meningitis as the first manifestation .Methods 32 Kawasaki disease patients with purulent meningitis as the first manifestation in our hospital were selected for the study ,clinical data were retrospectively analyzed .Results Before treatment ,white blood cells ,proteins and chlorides of CSF were higher than normal ,which were significantly decreased after treatment ;Detection of peripheral blood showed that the CRP ,ESR and platelet after treatment significantly reduced compared with those before treatment (P<0 .05);the serum sodium ,potassium ,chloride had little changes (P>0 .05) .When all cases treated by antibiotics and gamma globu‐lin ,24 patients were cured ,6 patients improved ,2 patients turned to surgical treatment ,no death ,the cure rate was 75% . After 3‐month follow‐up ,29 cases were in good prognosis with normal intelligence ,2 cases appeared to mental retardation symptoms ,one patient had mild limb movement disorder ,the overall cure rate was 90 .6% .Before treatment ,the turbid ap‐pearance of CSF occurred in 23 cases ,27 cases had positive globulin .After treatment the patients’ conditions improved ,be‐sides CSF muddy and positive globulin were significantly lower(P<0 .05) .Conclusion The treatment of Kawasaki disease with purulent meningitis as the first manifestation should combine with the clinical manifestations .In addition ,cerebrospinal fluid detection ,CT and ECG observation and rational application of antibiotics and gamma globulin can effectively improve the diagnosis rate so as to increase the cure rate and reduce the occurrence of adverse reactions .