新生儿化脓性脑膜炎临床分析  

Clinical Analyzing of Neonatal Purulent Meningitis

作　　者：高洁[1,2] 杨丽[1,3] 毛雪[1] 夏斌[1] 

机构地区：[1]四川大学华西第二医院儿科,成都610041 [2]四川省蒲江县人民医院儿科 [3]四川省长宁县人民医院儿科

出　　处：《中华妇幼临床医学杂志（电子版）》2014年第1期9-12,共4页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家自然科学基金资助项目(81370738);四川省卫生厅科学研究项目(060026)~~

摘　　要：目的 探讨新生儿化脓性脑膜炎的临床表现、治疗及转归.方法 采用回顾性分析法分析2008年1月至2012年12月于四川大学华西第二医院新生儿科住院治疗并确诊为新生儿化脓性脑膜炎的52例患儿的临床病历资料.对其临床表现、实验室检查结果、头颅影像学检查情况及临床转归进行分析（本研究遵循的程序符合四川大学华西第二医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象监护人的知情同意,并与其签署临床研究知情同意书）.结果 本组52例患儿中,61.54%（32/52）临床表现为反应差,57.69%（30/52）为发热,肌张力改变为51.92%（27/52）,惊厥为28.85%（15/52）,前囟张力增加为19.23%（10/52）,脑膜刺激征异常为3.85%（2/52）.本组患儿初次外周血感染指标检查结果和脑脊液（CSF）检查阳性率均不高,其中外周血C-反应蛋白（CRP）异常（阳性）率明显高于外周血白细胞（WBC）计数异常（降低或升高）率（63.50% vs.38.46%）,差异有统计学意义（P〈0.05）;CSF中WBC计数异常率明显高于蛋白含量异常率（67.31% vs.38.46%）,差异有统计学意义（P〈0.01）.从血液和CSF培养出的各种致病菌中,革兰阴性（G-）菌多于革兰阳性（G＋）菌,其中以大肠埃希菌最多,占26.92%（7/26）,100.00%（26/26）为条件致病菌,多重耐药菌占69.23%（18/26）.本组多数患儿均使用抗菌药物联合治疗,其中43例（82.69%）使用3代头孢菌素,20例使用美罗培南,3例使用4代头孢菌素（头孢吡肟）,3例使用万古霉素.其抗菌药物使用时间为（20.17±11.93）d（2～49 d）,治愈率为59.62%（31/52）.结论 新生儿化脓性脑膜炎的临床诊断困难.对该病的早期识别依赖于临床对具有高危因素患儿的密切临床监测和反复CSF检查.导致该病致病菌的耐药率高.该病的治疗疗效差、预后差.Objective To study the clinical manifestations, treatment and hospitalized outcomes of neonatal purulent meningitis. Methods This was a prospective observational study with institutional ethics approval of West China Second University Hospital, Sichuan University and written consent from the parents of each participating neonate. From January 2008 to December 2012,a total of 52 neonates with neonatal purulent meningitis in West China Second University Hospital, Sichuan University were recruited. Their clinical manifestations, lab examination results, head image results, and prognoses were analyzed respectively. Results The most frequently signs were low response（61.54%,32/52） and fever（57.69%,30/52）, the incidence of nerver system abnormal signs such as abnormal muscle tone（51.92%,27/52）,seizure（28.85%,15/52）,bulging fontanel（19.23%,10/52）and positive meningeal irritation sign（3.85%,2/52）was low among 52 neonates with neonatal purulent meningitis. The positive incidence of the first result of lab test including infection markers in blood and cerebrospinal fluid （CSF） was low also. There had significance difference between blood white blood cell （WBC） and C-reacting protein（CRP） （63.50% vs. 38.46%,P〈0.05）,and between WBC and protein amount in CSF （67.31% vs. 38.46%,P〈0.01）, respectively. The pathogenic bacteria raised from blood and CSF, Gram-negative（G-） bacteria were more than Gram-positive（G＋）, the Escherichia coli took the first place（26.92%,7/26）;All bacteria were conditional pathogenic bacteria, most of these were multiple resistant bacteria（69.23%,18/26）. Every patient received at least two antibiotics, the 3rd generation cephalosporin were the most popular（82.69%,43/52）,following meropenem（38.46%,20/52）,there were 3 cases used vancomycin and cefepime（4th generation cephalosporin）respectively. Conclusions To discriminate neonatal purulent meningitis early, we need a constant surveillance for neonatal having high risk factors of me

关 键 词：脑膜炎 细菌性 婴儿 新生 抗菌药 

分 类 号：R722.1[医药卫生—儿科]