Encephalitic meningitis yog kab mob kis kab mob, fungal lossis kab mob uas tshwm sim nws tus kheej raws li qhov mob ntawm daim nyias nyias ntawm lub hlwb thiab qaum qaum. Nws tuaj yeem ua rau tuag taus yog tias tsis kuaj thiab kho tam sim.
History
Muaj kev xav tias thaum lub sijhawm Hippocrates thiab Avicenna lawv paub txog qhov muaj tus kabmob no. Lawv puas tuaj yeem kho nws? Tsis yog lawm, vim hais tias nyob rau hauv lub ntiaj teb niaj hnub no nws tsis yog ib txwm muaj peev xwm txheeb xyuas qhov teeb meem raws sij hawm thiab teb rau nws. Thawj cov ntaub ntawv tau sau tseg hauv Scotland xyoo 1768, tab sis tom qab ntawd kev sib txuas nrog cov kab mob tsis pom meej. Cov kab mob sib kis tau hais txog thaum pib ntawm lub xyoo pua puv 19 hauv Geneva, thiab txawm hais tias nws tau tswj hwm los ntawm, nws tsis yog qhov kawg. Thoob plaws hauv lub xyoo dhau los thiab ib puas xyoo ua ntej kawg, encephalitis meningitis tshwm sim hauv Africa, Europe thiab Asmeskas.
Txog rau thaum xaus ntawm lub xyoo pua nees nkaum, tus neeg tuag los ntawm tus mob meningitis mus txog yuav luag ib puas feem pua, tab sis tom qab penicillin tau siv los tiv thaiv tus kab mob no hauv xyoo 1944, cov neeg cawm seej tau pib nce ntxiv. Cov tshuaj tiv thaiv kab mob sib kis kuj tau pabCov kab mob kab mob, nrog rau kev tsim cov tshuaj glucocorticoid.
Yog vim li cas
Los ntawm etiology, tus kab mob no tuaj yeem muab faib ua peb pawg:
- kis tau (provoked los ntawm ib qho kab mob tshwj xeeb);
- kis kab mob-kev ua xua (autoimmune puas rau daim nyias nyias ntawm lub hlwb hauv teb rau kev kis kab mob, tshuaj tiv thaiv lossis kab mob rheumatic); - tshuaj lom (tshwj xeeb rau cov tshuaj lom neeg, ua rau mob).
Tseem muaj cov kab mob thawj thiab theem nrab encephalitic meningitis. Raws li koj tuaj yeem twv, tus kab mob hu ua thawj zaug thaum lub hom phiaj ntawm kev kis kab mob nyob ncaj qha rau hauv lub hlwb. Qhov no tshwm sim nrog kev raug mob sab hauv (bruise, hematoma), kab mob los yog kis kab mob. Ib tus kab mob thib ob tshwm sim, xws li otitis media, sinusitis, tuberculosis lossis syphilis.
Kab mob kis
Yav dhau los, vim muaj neeg coob coob, kev huv huv tsis zoo thiab kev noj zaub mov tsis zoo, encephalitis meningitis feem ntau tshwm sim hauv cov menyuam yaus hnub nyoog qis dua tsib xyoos. Tab sis tam sim no cov xwm txheej no tsis tshua muaj vim yog kev txhim kho tshuaj thiab txhim kho kev ua neej nyob.
Feem ntau mob thaum lub caij ntuj no lig - thaum ntxov caij nplooj ntoos hlav. Nyob rau lub sijhawm no, vitamin tsis txaus thiab txo qis hauv kev tiv thaiv, nrog rau kev hloov pauv ntawm qhov kub thiab txias, tau pom meej meej. Qhov chaw nyob tas li kaw, chav cua tsis zoo kuj tseem muaj txiaj ntsig.
Encephalitic meningitis yog ubiquitous, tab sis feem ntau tshwm sim nyob rau hauv teb chaws Africa. Nyob rau hauv Russia, thawjqhov tshwm sim ntawm tus kab mob no tshwm sim ua ntej kev tshwm sim ntawm Ntiaj Teb Tsov Rog II, thib ob - nyob rau hauv lub yim caum ntawm lub xyoo pua xeem, thiab lub xeem - nyob rau hauv 1997.
Cov kab mob meningococcal thiab pneumococcal encephalitis feem ntau tshwm sim. Streptococcus pneumoniae muaj ntau tshaj yim caum antigenic ntau yam. Lub cev nws tus kheej tsis muaj zog, nyiam qhov chaw aerobic, tab sis nyob rau hauv cov xwm txheej tseem ceeb nws tuaj yeem ua tsis tau oxygen ib ntus. Cov duab ntawm tus kab mob yog oval, tsawg tshaj li ib micrometer nyob rau hauv lub cheeb, nws yog immobile, tsis muaj spores. Nws txhim kho zoo ntawm cov ntshav tawm ntawm tib neeg lub cev kub. Pneumococcal encephalitis meningitis yog kis los ntawm huab cua los ntawm ib tug neeg mob los yog convalescent neeg. Cov kab mob kis tau zoo heev rau cov teebmeem ntawm cov tshuaj, suav nrog tshuaj tua kab mob.
Pathogenesis
Tus kab mob pib nrog qhov tseeb tias cov kab mob nkag mus rau hauv txoj hlab pa sab saud thiab kho rau ntawm cov mucous ntawm nasopharynx lossis oropharynx. Cov kab mob virulence uas pneumococcus muaj (capsule, teichoic acid, tshuaj C) txhawb kev tsim cov prostaglandins, ua kom lub zog ntxiv thiab neutrophil leukocytes. Tag nrho cov no ua ke tsis ua rau mob encephalitis meningitis. Cov laj thawj rau nws qhov tsos yog qhov tob dua. Qhov twg cov kab mob tau colonized lub mucosa, o tshwm sim nyob rau hauv daim ntawv ntawm otitis media, sinusitis, frontal sinusitis los yog tonsillitis. Cov kab mob ntau, lawv cov co toxins ua rau lub cev tiv thaiv kab mob, thiab nrog cov ntshav ntwskis thoob plaws hauv lub cev, cuam tshuam rau lub plawv, pob qij txha, thiab, ntawm lwm yam, daim nyias nyias ntawm lub hlwb.
Clinic
Nyob hauv tsev kho mob, muaj peb hom kab mob encephalitic meningitis siv:
- mob, nrog rau adrenal tsis txaus thiab feem ntau tuag taus;
- ncua, thaum cov tsos mob nce zuj zus;- rov tshwm sim, nrog lub teeb me me.
Daim ntawv mob hnyav yog qhov tshwm sim tam sim ntawd tawm tsam keeb kwm yav dhau los ntawm kev noj qab haus huv tiav nrog qhov kub siab nce mus rau cov lej pyretic (39-40 degrees). Muaj pallor, tawm hws, cyanosis, ua rau poob ntawm kev nco qab thiab convulsions, nrog rau paresis ntawm lub ntsej muag nqaij. Hauv cov menyuam mos thiab menyuam mos, kev ntxhov siab yog tshwm sim los ntawm kev quaj tsis tu ncua. Los ntawm kev nce hauv intracranial siab, qhov sib txawv ntawm cov pob txha taub hau tuaj yeem ua tau, nrog rau cov pob txha ntawm fontanel. Hnub thib ob ntawm kev mob, cov tsos mob meningeal tshwm sim, xws li cov leeg txha caj dab. Tom qab peb mus rau plaub hnub, tus neeg mob poob rau hauv coma, thiab edema (vim cov tshuaj tiv thaiv inflammatory) ua rau herniation ntawm medulla oblongata.
Meningeal tsos mob
Cov no yog cov cim qhia ntawm qhov mob ntawm meninges. Lawv tshwm sim hauv thawj teev tom qab pib muaj tus kab mob thiab pab kom kuaj tau qhov tseeb.
- Txoj haujlwm ntawm tus taw qhia aub (lub taub hau pov tseg rov qab, ceg nqa mus rau lub cev).
- Kev nruj ntawm cov leeg ntawm caj dab thiab caj dab (passively khoov lub taub hautus neeg mob tus kws kho mob ua tsis tiav vim lub suab nrov ntawm cov leeg extensor).
- Kernig cov tsos mob (tus kws kho mob flexes tus neeg mob ceg ntawm lub duav thiab lub hauv caug sib koom ua ke, tab sis ntsib kev tawm tsam thaum sim kho nws).
- Upper Brudzinski cov tsos mob (thaum lub taub hau khoov, ob txhais ceg raug rub mus rau lub cev).
- Mean Brudzinski lub kos npe (ceg flexion nrog suprapubic siab).
- Lower Brudzinski kos npe (Thaum ib ceg yog passively flexed, lwm tus kuj coj mus rau hauv plab).
- Lessage tus tsos mob (tus menyuam mos, txhawb nqa caj npab, thaum nws ob txhais ceg raug nias tawm tsam lub cev).
- Mondonesi tus tsos mob (mob siab ntawm lub qhov muag).
- Bekhterev cov tsos mob (mob thaum tapping ntawm lub zygomatic arch).
- Ntaus rhiab heev rau stimuli, lub teeb thiab suab ntshai.
Nyob rau me nyuam
Nws nyuaj rau tus neeg laus tiv taus tus kab mob xws li encephalitic meningitis. Qhov tshwm sim hauv cov menyuam yaus tuaj yeem ua rau muaj kev ntxhov siab ntau dua, vim lawv tsis tshua yws yws ntawm cov kab mob, tsis txhob hnov qab txog kab tom thiab txo qis kev tiv thaiv. Cov tub hluas mob ntau dua cov ntxhais, thiab tus kab mob hnyav dua.
Txhawm rau tiv thaiv koj tus menyuam, koj yuav tsum hnav nws kom sov thaum lub caij nplooj ntoo hlav-lub caij nplooj zeeg, sab laj nrog kws kho mob hauv lub sijhawm me ntsis ntawm kev mob, thiab tshuaj xyuas nws sab nraud txhua ob peb teev nyob rau lub caij ntuj sov kom zuam tom thiab Lwm cov kab nqus ntshav.
Diagnosis
Rau tus kws kho mob ua ntejNws yog ib qho tseem ceeb kom paub meej tias qhov kev kuaj mob ntawm encephalitic meningitis. Nws puas kis tau? Undoubtedly. Yog li ntawd, tus neeg mob yuav tsum tau muab tso rau hauv ib lub thawv cais los yog nyob rau hauv lub chaw kho mob kis kab mob, tom qab ua qhov kev ntsuam xyuas ua ntej kis kab mob. Tom qab ntawd nws yog ib qho tsim nyog los sau ib qho anamnesis ntawm lub neej thiab kev noj qab haus huv, txhawm rau nrhiav kev tsis txaus siab. Kev kuaj lub cev muaj xws li kuaj xyuas cov tsos mob meningeal thiab ntsuas kub. Rau kev kuaj kuaj ntshav, ntshav thiab cerebrospinal kua.
Hauv kev kuaj ntshav dav dav, muaj qhov nce hauv qib ntawm leukocytes nrog rau qhov tseem ceeb ntawm cov ntawv hluas, qhov tsis muaj eosinophils thiab nce ESR nce mus txog rau caum millimeters ib teev. Cawv yuav pos huab, opalescent, nrog ib tug ntsuab tinge. Nws yog dominated los ntawm neutrophils thiab protein, thiab cov piam thaj txo qis. Txhawm rau txiav txim siab tus kab mob, ntshav, hnoos qeev lossis cerebrospinal kua yog sown rau ntawm cov khoom noj nruab nrab.
Kev kho mob
Yog tias lub tsheb thauj neeg mob lossis tus kws kho mob hauv chav kho mob xwm txheej ceev xav tias tus mob encephalitis meningitis, tus neeg mob tau mus pw hauv tsev kho mob tam sim ntawd. Kev kho mob pib tam sim ntawd, tsis tas tos rau kev kuaj xyuas qhov kev kuaj mob. Kev pw tsaug zog nruj, noj zaub mov muaj calorie ntau ntau.
Pib nrog cov tsos mob thiab kho kab mob. Ua ntej tshaj plaws, koj yuav tsum tau ntxuav lub cev ntawm cov co toxins uas cov kab mob tsim, nrog rau txo qis intracranial siab thiab nyias cov ntshav. Rau qhov no, tus neeg mob tau txhaj tshuaj saline nrog cov piam thaj thiab diuretics. Vim tias dej nyab ntau dhau ntawm lub cev tuaj yeem ua rau herniation ntawm medulla oblongata thiab tuag tam sim. Tsis tas li ntawd, tshuaj los txhim khomicrocirculation, vasodilators thiab nootropics txhawb lub hlwb ua haujlwm.
Etiological therapy muaj cov tshuaj tua kab mob (benzylpenicillins, fluoroquinolones, cephalosporins).
Exodus
Txhua yam nyob ntawm ntau npaum li cas sai thiab ua tiav pib kho mob encephalitis meningitis. Qhov tshwm sim tuaj yeem yog me me yog tias muaj kev pabcuam raws sijhawm. Thiab nyob rau tib lub sijhawm, nrog rau qhov mob hnyav thiab ceev ceev, kev tuag nce mus txog yim caum feem pua. Tej zaum yuav muaj ntau qhov laj thawj rau qhov no:
- cerebral edema thiab herniation;
- cardiopulmonary tsis ua hauj lwm;
- sepsis;- DIC.
Kev Tiv Thaiv
Meningitis encephalitis tiv thaiv tau los ntawm kev txhaj tshuaj tiv thaiv menyuam yaus hnub nyoog ob txog tsib xyoos ntawm cov neeg muaj kev pheej hmoo. Nws kuj raug pom zoo rau cov neeg muaj hnub nyoog tshaj rau caum tsib xyoos. Cov tshuaj tiv thaiv no suav nrog hauv lub sijhawm ua haujlwm ntawm WHO txhaj tshuaj tiv thaiv thiab siv nyob rau ntau lub tebchaws hauv ntiaj teb.
Tam sim no, nyob rau hauv lub ntiaj teb thib peb lub teb chaws, cov pej xeem tseem ntshai ntawm kev kuaj mob encephalitis meningitis. Peb puas tuaj yeem kho nws? Yog, twv yuav raug hu. Tab sis kev vam meej nyob ntawm seb yuav pab sai npaum li cas thiab yuav ua li cas.
