影响新生儿化脓性脑膜炎非治愈出院因素的分析  

Evaluation about risk factors of neonatal purulent meningitis in clinical uncure hospitalized neonates

作　　者：齐薛浩 杨琳[1] 王悦宁[2] 王文静 QI Xuehao;YANG Lin;WANG Yuening;WANG Wenjing(Department Pediatric,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004;Department NICU,Xi'An Children's Hospital Affiliated of Xi'an Jiaotong University,Xi'an 710003, China)

机构地区：[1]西安交通大学第二附属医院儿科,陕西西安710004 [2]西安交通大学附属西安市儿童医院NICU科,陕西西安710003

出　　处：《国外医学（医学地理分册）》2019年第1期22-26,共5页Foreign Medical Sciences：Section of Medgeography

基　　金：国家自然科学基金资助项目(30973224)

摘　　要：目的新生儿化脓性脑膜炎预后一直是临床工作中关注点。本病具有发病率高,死亡率高,致残率高三大特点。近年来,其病死率呈逐年下降趋势,但是病残率下降并不明显,神经系统后遗症比较多见,此类患儿基本包含在新生儿病房非治愈出院的人数中,以出院结局为分组因素,将非治愈出院的患儿与治愈出院患儿进行对照分析,探讨可造成非治愈出院患儿的相关因素,为预测新生儿化脓性脑膜炎不良预后提供思路及理论依据。方法本研究收集西安交通大学附属西安市儿童医院新生儿科2015年1月至2016年12月期间确诊为新生儿化脓性脑膜炎患儿的临床病历,按照诊断标准及研究信息要求,整理出相关资料,共计患儿168例。采用回顾性研究方法,收集患儿一般情况(患儿性别、出生体质量、日龄、发病时间等)、围生期相关因素(胎膜早破、宫内窘迫、羊水污染,母亲病史等)、临床症状和体征(反应、吃奶、惊厥、肌张力、原始反射等)、辅助检查(白细胞计数、血小板计数、脑脊液细胞数、脑脊液葡萄糖、脑脊液蛋白、血培养等)和治疗相关(抗生素使用、住院天数、呼吸机支持等)资料;根据患儿出院时转归情况将患儿分为治愈出院组和非治愈出院组,两组之间进行比较和统计分析。临床资料中计数资料以率(%)表示,计数资料组间比较采用χ~2检验(若理论频数小于1,则采用Fisher'精确概率法),计量资料采用t检验,不能满足t检验要求时采用非参数秩和检验,结果均以ɑ=0.05为检验水准,P<0.05为有统计学意义。结果非治愈组患儿40例,出院原因依次为:病情严重,有严重并发症,预后不良可能性大14(35.0%)例;经治疗后脑脊液指标部分有好转,但未正常,有合并症,住院时间较长21(52.5%)例;合并疾病未治愈,好转出院4(10.0%);入院姓名有误,临床治疗好转,疗程不足,因改名字1(2.5%)例。在一般情况方Objective Prognosis of neonatal purulent meningitis has always been a focus in clinical work. The disease has a high morbidity, high mortality and high disability rate. In recent years, the case fatality rate decline year by year, but the disability rate does not decline obviously. The part of children is contained in clinical uncure hospitalized neonates. These children were divided into cure group and uncure group according to the results of cure. Compared the differences of two groups to analysis the factors related to the uncure of purulent meningitis in neonates and to predict the possibility of neonatal purulent meningitis poor prognosis. Methods 168 neonates who diagnosed with purulent meningitis at the neonatal department of xi’an jiaotong university affiliated xi’an children’s hospital during January 2015 to December 2016, were retrospectively analyzed with the clinical data and divided into uncure group and cure group according to the results of cure. Compared the differences of two groups on the general situation(sex, birth weight, age, Sick time, etc.), perinatal period factors(premature rupture of membranes, intrauterine distress, amniotic fluid contamination, mother’s medical history, etc.), clinical manifestations(reaction, nursing, convulsions, muscle tension, and primitive reflex), the results of laboratory examinations(white blood cell count, platelet count, cerebrospinal fluid cell count and CSF glucose, CSF protein, blood culture, etc.)and related treatmen(antibiotic, hospitalization days, ventilator support, etc.), to analysis the factors related to the prognosis of purulent meningitis in neonates. Clinical data of count data expressed as a ratio(%), comparison between count data set using chi-square test(if the theory of frequency is less than 1, the Fisher’exact probability method is used), measurement data using t test, can not meet the requirement of the t test, when using nonparametric rank and inspection, the results are ɑ=0.05 as the inspection level, P<0.05 as the standard

关 键 词：新生儿化脓性脑膜炎 新生儿 影响因素 非治愈 

分 类 号：R725[医药卫生—儿科]