儿童化脓性脑膜炎267例合并脑积水临床研究  

Clinical features of hydrocephalus in 267 cases of childhood purulent meningitis

作　　者：霍亮[1] 姜春颖 范玉颖[1] 高健[2] 王华[1] HUO Liang;JIANG Chun-ying;FAN Yu-ying(Department of Pediatric Neurology,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院小儿神经内科,辽宁沈阳110004 [2]中国医科大学附属盛京医院影像科,辽宁沈阳110004

出　　处：《中国实用儿科杂志》2018年第7期532-537,共6页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨儿童化脓性脑膜炎合并脑积水的临床特征。方法选取2010年1月至2016年12月中国医科大学附属盛京医院小儿神经内科化脓性脑膜炎且年龄<14岁的267例患儿,收集符合入组标准患儿的临床资料进行回顾性分析,所有资料均应用SPSS13.0版统计软件进行统计学处理。结果共计收集267例化脓性脑膜炎患儿,其中脑积水的发生率为9.36%(25/267),在25例并发脑积水患儿中,发病年龄主要集中在6个月以内,从发病到确诊脑积水的时间多为1~4周。并发脑积水患儿中15例有明确病原学检查结果:大肠埃希菌6例、肺炎链球菌2例、葡萄球菌2例、B组溶血性链球菌2例,鲍曼不动杆菌2例、李斯特菌1例。梗阻性脑积水占48%(12/25)。56%(14/25)的患儿经历了抗生素提早治疗方案。并发脑积水患儿预后:存活12例、死亡1例、失访12例。并发脑积水的相关因素包括:居住农村(OR:17.64;95%CI 1.23~252.86)、意识改变(OR:7.59;95%CI1.09~52.86)、首次脑脊液中蛋白>2 g/L(OR:177.02;95%CI 3.53~8866.51)、C反应蛋白>100mg/L(OR:52.29;95%CI 3.26~840.19)、初始治疗采用两种抗生素(OR:0.06;95%CI 0.01~0.62)、使用地塞米松(OR:149.47;95%CI 2.56~8713.78)以及入院前应用过抗生素(OR:36.28;95%CI 2.84~462.78)。结论脑积水是化脓性脑膜炎的严重并发症。严重的临床表现以及显著异常的实验室指标是化脓性脑膜炎患儿发生脑积水的重要预测因素。Objective To explore the clinical characteristics of hydrocephalus in children with purulent meningitis.Methods The children,aged14 years,treated for purulent meningitis at the Shengjing Hospital of China Medical University during the period from January 2010 to December 2016,were retrospectively enrolled in the study. The clinical data of every child who fulfilled the criteria were obtained and analyzed. Data were analyzed using the Statistical Package for Social Sciences（SPSS）13.0. Results The morbidity of hydrocephalus in children with purulent meningitis was 9.36%（25/267）. In these cases with hydrocephalus,the age of onset was mainly under 6 months old,and the period from onset to diagnosis of hydrocephalus was mainly 1-4 weeks. Fifteen cases of hydrocephalus had a confirmed bacterial etiology as follows：Escherichia coli（n=6）,Streptococcus pneumoniae（n=2）,staphylococcus（n=2）,Group B beta-hemolytic streptococcus（n=2）,acinetobacter（n=2）and Listeria monocytogenes（n=1）. The incidence of obstructive hydrocephalus was 48%（12/25）. About56% patients received a previously treatment with antibiotics. The prognoses of these children were：survival in 12 cases,death in 1 case and loss of follow-up in 11 cases. The related factors of the development of hydrocephalus included：a rural living situation（OR：17.64;95%CI 1.23~252.86）,altered level of consciousness（OR：7.59;95%CI 1.09~52.86）,CSF protein2.0 g/L（OR：177.02;95%CI 3.53~8866.51）,C-reactive protein100 mg/L（OR：52.29;95%CI 3.26~840.19）,initial therapy with dual-agent antibiotic（OR：0.06;95%CI 0.01~0.62）,dexamethasone use（OR：149.47;95%CI 2.56~8713.78）and previous treatment with antibiotics（OR：36.28;95%CI 2.84~462.78）. Conclusion Hydrocephalus is a serious complication of purulent meningitis. The severe clinical manifestations and significantly abnormal laboratory indexes represent the most important predictor of hydrocephalus in children with purulent meningitis.

关 键 词：儿童 化脓性脑膜炎 脑积水 

分 类 号：R72[医药卫生—儿科]