德国关于社区获得的成年人急性细菌脑膜炎的指南
Matthias Klein1,2, Carsten Abdel-Hadi3, Robert Bühler4
1Department of Neurology, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany. matthias.klein@med.uni-muenchen.de.
Neurological research and practice
|August 30, 2023
概括
本指南为成年人急性细菌性脑膜炎的诊断和治疗提供了建议. 早期诊断和治疗,包括腰椎大脑脊髓液分析和及时的抗生素和德克萨米他松的管理,对于改善患者的治疗结果至关重要.
科学领域:
- 神经学 神经学
- 传染性疾病 传染性疾病
- 关键护理医学 关键护理医学
背景情况:
- 社区获得的急性细菌性脑膜炎的发病率有所下降.
- 尽管发病率下降,但死亡率和长期后果仍然显著.
- 需要指导方针来规范成人细菌脑膜炎的诊断和治疗.
研究的目的:
- 为成人急性细菌脑膜炎的诊断和治疗提供最新的建议.
- 为指导医生管理疑似或确诊的细菌性脑膜炎患者.
- 通过概述诊断和治疗方面的最佳实践来改善患者的治疗结果.
主要方法:
- 德意志神经系统学会 (DGN) 开发了德国S2k指南.
- 由劳动科学医学专业社团 (AWMF) 提供的指导.
- 基于当前证据的推,用于检查,诊断和治疗.
主要成果:
- 建议立即收集腰部脑脊液 (CSF) 和血液培养,进行临床后检查 (如果没有禁忌).
- 经验性静脉注射德克萨米他和抗生素应立即给予.
- 推的初始实证抗生素治疗方案包括安培素和3a组的胞素 (例如, ceftriaxone).
结论:
- 在患有严重症状 (意识受损,焦点缺陷,发作) 的患者中,在采血后开始使用德克萨和抗生素,然后在成像后采取CSF样本.
- 由于潜在的并发症,建议在初始阶段进行重症监护室 (ICU) 治疗.
- 特别建议对意识受损的患者进行ICU管理,最好是在经历过严重中枢神经系统 (CNS) 疾病的病房.
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