细菌性脑膜炎并脑积水的临床特点及危险因素  

Clinical Features and Risk Factors of Hydrocephalus in Children with Bacterial Meningitis

作　　者：刘敏[1] 庞玉生[1] 石靖[1] 

机构地区：[1]广西医科大学第一附属医院儿科,南宁530021

出　　处：《实用儿科临床杂志》2012年第10期774-776,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨细菌性脑膜炎并脑积水的临床特点,并分析其相关的危险因素,以降低其发生率,改善细菌性脑膜炎的预后。方法对2004年1月-2010年6月本院收治的111例细菌性脑膜炎患儿的临床资料进行回顾性分析。根据影像学结果,将患儿分为细菌性脑膜炎并脑积水组(n=16)及细菌性脑膜炎无脑积水组(n=95),应用SPSS 17.0软件对2组患儿的基本情况、临床表现、实验室结果及抗生素治疗情况等进行比较,对相关因素进行Logistic回归分析,筛选出脑积水发生的高危因素。结果细菌性脑膜炎并脑积水的发生率为14.4%(16/111例),以梗阻性脑积水为主(14/16例,87.5%),75%(12/16例)患儿脑积水出现在起病4周内,确诊时CT/MRI的检查次数为1～3次,2例患儿在起病后2个月行脑室-腹腔分流术,2例脑积水患儿死亡。2组临床资料比较显示年龄、发热>10 d、惊厥、意识障碍、经验性治疗失败、颅内低密度灶、低Hb水平、高脑脊液蛋白水平、低脑脊液葡萄糖水平均与脑积水发生有关(Pa<0.05),Logistic回归分析显示意识障碍、经验性治疗失败、低Hb水平是细菌性脑膜炎并脑积水的独立危险因素。结论脑积水是细菌性脑膜炎的一个严重并发症之一,临床表现及实验室检查结果可作为细菌性脑膜炎并脑积水的预测指标。Objective To explore the clinical characteristics and correlated risk factors of hydrocephalus secondary to bacterial meningitis in children, in order to reduce its incidence and improve the outcome of bacterial meningitis. Methods The study was retrospectively performed on 111 patients at the First Affiliated Hospital of Guangxi Medical University ,from Jan. 2004 to Jun. 2010 ,with the diagnosis of bacterial meningitis. All cases were divided into bacterial meningitis with hydrocephalus group and without hydrocephalus group according to neu- roimaging findings. The clinical and laboratory data of patients with and without hydroeephalus were analyzed and compared by SPSS 17.0 software. Results Hydrocephalus patients accounted for 14.4% （ 16/111 cases） of bacterial meningitis cases. A total of 75% （ 12/16 cases） hydrocephalus manifested itself within 4 weeks following the disease＇s onset. Fourteen cases （ 14/16 cases, 87.5% ） were obstructive hydro- cephalus. One to three times repeated CT/MRI were performed when hydrocephalus was diagnosed. Two cases with hydrocephalus required ventriculoperitoneal shunt at 2 months after bacterial meningitis was onset. Two patients with hydrocephalus were died. There were significant differences between the both groups at admission included young age, prolonged fever 〉 10 d, the presence of seizures, impaired consciousness, empirical treatment failure, cerebral infarction,low haemoglobin level, high cerebrospinal fluid（CSF） protein level and low CSF glucose level. The Logistic regression analysis showed that impaired consciousness, empirical treatment failure and low haemoglobin level were independent risk factors of hydrocephalus secondary to bacterial meningitis. Conclusions Hydrocephalus was one of the severe sequelaes of bacterial meningitis. Certain clinical parameters and laboratory findings in blood and CSF at the time of admission can be used as predictors for hydrocephalus in bacterial meningitis.

关 键 词：脑积水 细菌性脑膜炎 危险因素 儿童 

分 类 号：R742.9[医药卫生—神经病学与精神病学]