婴儿脓毒症并化脓性脑膜炎86例临床分析  

Clinical analysis of 86 infantile sepsis complicated with suppurative meningitis cases

作　　者：余洁明[1] 王杏[1] 吴春远[1] 刘海英[1] 刘瑜[1] 

机构地区：[1]南方医科大学附属深圳市妇幼保健院儿科,518028

出　　处：《中国实用医药》2017年第14期7-10,共4页China Practical Medicine

摘　　要：目的通过对婴儿脓毒症并发化脓性脑膜炎的临床特点、脑脊液分析、病原菌情况及治疗预后的分析,探讨其早期诊断和及时治疗的措施。方法 86例确诊脓毒症合并化脓性脑膜炎的婴儿作为研究对象,回顾性分析其临床表现、实验室检查及治疗预后情况。结果本组患儿均有发热,并且以脓毒症为首诊表现。86例婴儿期发病患儿中<3个月的小婴儿发病率为60.5%(52/86)。<3个月组较≥3个月患儿组更容易出现高热寒战、精神萎靡、易激惹、循环功能障碍等症状和前囟饱满等体征(P<0.05);而两组尖叫、抽搐及脑膜刺激征发生情况比较差异无统计学意义(P>0.05)。<3个月组较≥3个月组患儿更易并发严重脓毒症、脓毒性休克、颅内压增高征及脑性低钠血症等合并症(P<0.05)。<3个月组较≥3个月组患儿更易出现硬膜下积液等后遗症(P<0.05),而两组脑室膜炎、脑积水及癫痫等后遗症发生情况比较差异无统计学意义(P>0.05)。经过临床治疗86例均好转出院,有硬膜外积液影像学改变7例,随诊脑电图异常14例。结论婴儿的全身感染常以脓毒症为主要表现,常见的感染部位中,颅内感染容易被忽略。而<3个月的小婴儿更易并发严重脓毒症、脓毒症休克等危重症,常有明显硬膜下积液、脑积水、脑功能影响等后遗症。因此,以脓毒症为首诊表现的婴幼儿应特别警惕颅内感染,尽可能早期明确感染部位,防止漏诊。争取在抗生素使用之前取得脑脊液的标本,在首诊1 h内给予广谱抗生素,尤其是能较好地通过血脑屏障的抗生素治疗,可降低婴幼儿脓毒症并化脓性脑膜炎的病死率,改善患儿预后。Objective To analyze clinical characteristics, cerebrospinal fluid study, pathogenic bacteria condition and treatment prognosis in infantile sepsis complicated with suppurative meningitis, and to investigate measures for early diagnosis and timely treatment. Methods A retrospective analysis was made on clinical manifestations, laboratory examination and treatment prognosis condition of 86 infants with diagnosed sepsis complicated with suppurative meningitis. Results All infant patients showed manifestation of fever, with sepsis as the initial diagnosis performance. Infants 〈3 months old among the 86 infants had morbidity as 60.5% （52/86）. Infants 〈3 months old showed easier trend of having symptoms of hyperpyrexia and shiver, cachexia, irritability, circulatory dysfunction, and vital sign of bulging anterior fintanelle than infants ≥ 3 months （P〈0.05）. There was no statistically significant difference of occurrence of scream, convulsion and meningeal irritation sign between the two groups （P〉0.05）. Infants 〈3 months old showed easier trend of having complications of severe Sepsis, septic shock, intracranial hypertension sign and cerebral hyponatremia than infants ≥3 months （P〈0.05）. Infants 〈3 months old showed easier trend of having sequela of subdural effusion than infants ≥ 3 months （P〈0.05）, while there was no statistically significant difference of occurrence of ventriculitis, hydrocephalus and epilepsy as sequela between the two groups （P〉0.05）. After clinical treatment, all 86 cases were cured and discharged, and there were 7 cases with imageological change in epidural effusion and 14 cases with abnormal electroencephalogram. Conclusion Infantile general infection often has main manifestation as sepsis, and intracranial infection is easily ignored as one of the common infection sites. Infants 〈3 months old show easier trend of having critical disease of complicated severe sepsis, septic shock, and obvious sequela of subdural effusion, hydrocephalus and affe

关 键 词：婴儿 化脓性脑膜炎 脓毒症 临床分析 

分 类 号：R720.597[医药卫生—急诊医学] R725.1[医药卫生—儿科]