42例儿童化脓性脑膜炎的临床分析  

Clinical Analysis of 42 Children with Purulent Meningitis

作　　者：邓巧儿 唐丹霞[1] 李平甘[1] 何展文[1] 罗向阳[1] 李栋方[1] TANG Hao I;TANG Dan-xia;LI Ping-gan;HE Zhan-wen;LOU Xiang-yang;LI Dong-fang(Pediatrics department of Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,Guangzhou,510120)

机构地区：[1]广州市中山大学孙逸仙纪念医院儿科

出　　处：《岭南急诊医学杂志》2019年第6期560-563,共4页Lingnan Journal of Emergency Medicine

基　　金：中山大学精品视频公开课建设项目(81000-18832601)

摘　　要：目的:总结儿童化脓性脑膜炎的诊治特点及探讨影响预后的危险因素。方法:回顾性分析我院儿科2008年3月至2018年2月收治确诊为化脓性脑膜炎的42例患儿的临床资料。以发病年龄分新生儿组及非新生儿组;按随访结果分预后不良组及预后良好组。结果:非新生儿组出现嗜睡和抽搐症状比例、发热最高体温均>新生儿组;非新生儿组脑脊液(CSF)中的蛋白水平(出、入院)、CSF中的白细胞水平(出院)<新生儿组,预后不良组CSF蛋白水平(出院)、CSF葡萄糖降低发生率(入院)>预后良好组;预后不良组发病年龄、CSF葡萄糖水平(入院)<预后良好组,差异均有统计学意义(P<0.05);多因素Logistic回归分析示出院时CSF中蛋白浓度值是影响化脓性脑膜炎不良预后的独立危险因素。结论:儿童化脓性脑膜炎患儿出院前脑脊液的蛋白值越高;预后可能越差,新生儿化脓性脑膜炎的临床表现更隐匿,对可疑病例应尽早作辅助检查以协助诊治。免疫治疗可调节改善患儿体内免疫状态,但对远期预后的作用还有待观察。Objective:To summarize the characteristics of diagnosis and treatment of purulent meningitis(PM)in children.Methods:42 hospitalized children with purulent meningitis were enrolled from the pediatrics department of Sun Yat-Sen Memorial Hospital,Guangzhou from March 01,2008 to February 28,2018.All cases were divided into two groups according to the age of onset(Neonatal and Non-neonatal group.)Patients were followed up for 12 months after onset.The cases were also put into two groups according to the Glasgow Outcome Score(GOS),while score(5)was good,and score(1-4)was poor.Results:The clinical manifestations of Non-neonatal group showed a higher frequency of drowsiness,convulsions and maximumtemperature than Neonatal group.The value of protein concentration in cerebrospinal fluid(CSF)at admission and discharge,and the white blood cell value in CSF at discharge of Nonneonatal group was lower than those in the Neonatal group.In the poor prognosis group,the CSF glucose reduction rate at admission,and the value of protein concentration in CSF at discharge were higher than those in the good prognosis group respectively while showing a lower CSF glucose value at admission than opposite one.The poor prognosis group showed a lower age of onset than the opposite one.Multivariate logistic regression analysis showed the value of protein concentration in CSF at discharge was the in dependent risk factor for poor prognosis of PM.Conclusion:The high protein value of CSF at discharge is a high risk for the poor prognosis in children with PM.The clinical manifestations are likely concealed in neonatal purulent meningitis and further investigation should be performed for the early diagnosis and treatment of the suspicious patients.Immunotherapy can modulate and improve the immune status of children,but its effect on long-term prognosis remains to be observed.

关 键 词：儿童化脓性脑膜炎 临床分析 危险因素 预后 

分 类 号：R742.9[医药卫生—神经病学与精神病学]