新生儿细菌性脑膜炎的临床研究进展  

Clinical research progress of neonatal bacterial meningitis

作　　者：韦巧珍[1] 吕海生[2] 

机构地区：[1]玉林市第一人民医院新生儿科,537000 [2]玉林市第一人民医院儿内科,537000

出　　处：《中华实用儿科临床杂志》2014年第22期1756-1758,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：新生儿细菌性脑膜炎可引起严重的神经系统后遗症，且病死率高，不同的地区、不同的发病日龄其病原学特点不同。该病缺乏特异的临床表现，易导致诊断及治疗的延误，确诊需要腰穿了解脑脊液培养和生化参数情况，但脑脊液培养阳性率极低，生化参数在早期和经抗生素治疗后敏感性下降，反转录-PCR技术可以提高早期诊断的特异性和敏感性，但费用昂贵并受技术条件限制，因此临床医师需时刻警惕，对有可疑患儿需及时甚至反复进行腰椎穿刺检查。三代头孢类抗生素是革兰阴性杆菌的首选药物，革兰阳性球菌首选万古霉素，激素的应用仍不主张。因该病的神经系统后遗症发生率较高，治疗过程及时进行头颅影像学检查等方面是判断预后的重要手段。Neonatal bacterial meningitis may lead to severe neurological sequelaes,with a high mortality rate. It shows different etiology characteristics in different regions and different days of age. The lack of specific clinical mani- festations of the disease, easily lead to delays in diagnosis and treatment. Diagnosis needs to realize cerebrospinal fluid （CSF） cuhure and biochemical parameters by lumbar puncture, however, the rate of positive in CSF culture is extremely low, and the sensitivity in biochemical parameters in the early days and after treatment with antibiotics may be de- creased. The reverse transcription-PCR technique may improve the early diagnosis of specificity and sensitivity, but which is expensive and restricted by technical conditions, therefore, clinicians should be alert to the suspicious children and to check in time even repeated lumbar puncture. The third generation of cephalosporins antibiotics are the choices for gram-negative bacilli, gram-positive coccus preferred vancomycin, hormone application is still not advocate. Because of greater incidence of neurological complications of bacterial meningitis in neonates, head imaging examination timely in treatment process is an important means of assessing prognosis.

关 键 词：细菌性脑膜炎 糖皮质激素 后遗症 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]