儿童肺炎链球菌脑膜炎临床分析  

Clinical analysis of pneumococcal meningitis in children

作　　者：熊道学[1] 姜建渝[1] 冯琰[1] 隆福娟 XIONG Daoxue ,JIANG Jianyu ,FENG Yan ,LONG Fujuan(Department of Children＇s Critical Care Medicine ,Chongqing Three Gorges Central Hospital ,Chongqing 404000 ,Chin)

机构地区：[1]重庆三峡中心医院儿童重症医学科,重庆404000

出　　处：《中国实用神经疾病杂志》2018年第11期1244-1249,共6页Chinese Journal of Practical Nervous Diseases

摘　　要：目的总结分析儿童肺炎链球菌脑膜炎的临床特征。方法回顾分析2012-01—2017-12三峡中心医院儿童分院收治的14例肺炎链球菌脑膜炎患儿的临床资料。14例患儿,均未接种过肺炎链球菌疫苗;临床主要表现为发热、呕吐、意识障碍、惊厥、颈项强直、白细胞增高、脑脊液典型化脓性脑膜炎改变,部分患儿可出现白细胞减少、华弗综合征;药敏试验未发现万古霉素耐药病例;所有患儿均给予常规抗感染、降颅压及对症支持综合治疗,其中,12例使用万古霉素,7例予以机械通气,2例行CBP(连续性血液净化)治疗。结果 10例治愈或好转出院,死亡4例,其中2例为脑疝后脑死亡,另2例为脓毒症休克继发多器官功能衰竭;复发1例。结论肺炎链球菌脑膜炎具有发病率高、病情进展快、病死率高等特点,尤其是合并脓毒症休克及短期内出现脑疝者,大多预后不良,早期万古霉素使用、呼吸循环支持、CBP治疗可能更好改善预后。疫苗接种可能为减少发病及复发的有效措施。Objective To summarize the clinical features of pneumococcal meningitis in children.Methods A retrospective analysis of the 14 children clinical features with pneumococcal meningitis in the children＇s branch of the three gorges central hospital from January 2012 to December 2017 was applied.The 14 cases of pneumococcal meningitis,none of them had been vaccinated against pneumococcal conjugate vaccine.The main clinical manifestations were fever,vomiting,consciousness disorder,convulsion,neck stiffness,leukocyte increased,and typical Cerebrospinal fluid of purulent meningitis.Among of them,there leukocyte decreased and Water-house-Friderichsen syndrome.No vancomycin resistance was detected in the drug susceptibility test.All children were treated with anti-infection,reducing intracranial pressure and symptomatic treatment.12 cases received vancomycin,7 cases received mechanical ventilation and 2 cases received CBP（continuous blood purification）.Results 10 cases survived and 4 cases died,2 cases died of cerebral hernia,and 2 cases died of sepsis secondary to multiple organ failure.1 case had recurrence.Conclusion Pneumococcal meningitis has a high morbidity,rapid progression,and high mortality,especially with septic shock and cerebral hernia occurred in the short time,mostly had a poor prognosis.Early used of vancomycin,mechanical circulatory supported,and CBP therapy may improve the prognosis.Vaccination may be an effective measure to reduce the morbidity and recurrence.

关 键 词：肺炎链球菌 脑膜炎 儿童 耐药 脓毒症 复发 万古雷素 脑疝 

分 类 号：R512.3[医药卫生—内科学]