化脓性腹膜炎的诊断与鉴别诊断

1、主要内容 掌握化脓性脑膜炎的主要致病菌 掌握化脓性脑膜炎的临床表现 熟悉化脓性脑膜炎的诊断与鉴别诊断 掌握化脓性脑膜炎的常见并发症 掌握化脓性脑膜炎的治疗原则 General Introduction Bacterial Meningitis: infection of central nervous system (CNS); a rapidly progressive, diffuse infection involving the menings and cerebrospinal fluid (CSF) Peak age of incidence: younger than 5 yea

2、rs old Common clinical features: fever, increased intracranial pressure, meningeal irritation A serious infection in children: with a 5-10% mortality, high risk of neurological sequelae(30%) Early diagnosis and effective treatment improve the outcome 化脓性脑膜炎 化脓性脑膜炎 脑膜炎双球菌 肺炎双球菌 流感嗜血杆菌 三种菌占小儿脑膜炎2/3以上

3、易发生大肠杆菌、葡萄球菌、甚至绿脓杆菌等感染 化脓性脑膜炎-病因 （Major risk factors for meningitis） Immature immunologic function - Low level of immunoglobulin Immature blood-brain-barrier ( BBB) function or impaired BBB structure - BBB function maturation at about 1yr - Congenital or acquired defects of BBB 化脓性脑膜炎-病因 新生儿新生儿 3月月

4、1岁岁 IgM 0 50% 70% IgG 6070% （母供）（母供） 最低最低 60% 化脓性脑膜炎-病因 Hematogenous dissemination ） paranasal sinuses, middle ear） anatomic defects in the skull head trauma） 化脓性脑膜炎-病因 Typical access of Bacteria invasion -hematogenous dissemination Colonizing the mucous membranes of the nasopharynx Invasion into lo

5、cal tissue Bacteremia Hematogenous seeding to the subarachnoid space 化脓性脑膜炎-病因 脑膜结构 化脓性脑膜炎 化脓性脑膜炎 化脓性脑膜炎 化脓性脑膜炎临床表现 化脓性脑膜炎-临床表现 化脓性脑膜炎-临床表现 Signs of systemic infection Increased intracranial pressure meningeal irritation Typical (older children) Fever, altered consciousness, seizure Headache, vomiti

6、ng, herniation nuchal rigidity, back pain, kernig sign, brudzinski sign Atypical (neonate & 50 x106/L； 化脓性脑膜炎并发症 包括：交通性脑积水、非交通性脑积水 化脓性脑膜炎并发症 化脓性脑膜炎 化脓性脑膜炎治疗 化脓性脑膜炎治疗 EtiologyStandard antibiotics of choiceDuration of therapy H.influenzaeCefotaxime /Ceftriaxone7-10days N.meningitidisCefotaxime /Ceftri

7、axone7days S.pneumoniaeCefotaxime /Ceftriaxone2-3weeks Staphlococcus aureus Semisynthetic penicillins (Oxacillin sodium, Cloxacillin sodium),Norvancomycin 3weeks E.coliCefotaxime /Ceftriaxone (or + ampicillin) 3weeks UnknownCefotaxime/Ceftriaxone + ampicillin2-3weeks Antibiotic therapy of bacterial meningitis (Pathogen known: based on the results of drug-sensitive tests) 化脓性脑膜炎治疗 保证热量及水分：注意抗利尿激素综合征。水分供给：边补边脱原则， 60-80ml/kg/day； 降低颅内高压：20%甘露醇1-2g/kg/次，q4-6h，可与皮质激素（地塞米 松0.3-0.5mg/kg/day）联合使用 硬膜下积液：少量自行吸收，量多反复穿刺放液。一般一侧放液15ml/次， 两侧不超过30ml。每日或隔日反复穿刺。3-4周不愈者手术剥离包膜。 控制惊厥：安定、鲁米那等 其它 -