81例新生儿化脓性脑膜炎临床分析  

Clinical analysis of 81 cases of neonatal purulent meningitis

作　　者：郑孟秋 曹传顶 丁颖[1] 王铭杰[1] 廖正嫦[1] 岳少杰[1] ZHENG Meng-qiu;CAO Chuan-ding;DING Ying;WANG Ming-jie;LIAO Zheng-chang;YUE Shao-jie(Department of Neonatology, Xiangya Hospital,Central South University, Changsha 410008, China)

机构地区：[1]中南大学湘雅医院新生儿科,湖南长沙410008

出　　处：《中国感染控制杂志》2020年第5期440-446,共7页Chinese Journal of Infection Control

摘　　要：目的探讨新生儿化脓性脑膜炎的临床特点,为早期诊疗新生儿化脓性脑膜炎提供依据。方法回顾性分析2011年1月1日—2018年12月31日某院新生儿病房住院治疗且出院诊断为化脓性脑膜炎新生儿的临床资料,按照起病时出生后日数,以及血培养、脑脊液(CSF)培养结果分成不同组,比较不同组新生儿临床特点的差异。结果81例新生儿居前4位的临床表现依次为发热(88.89%)、意识改变(37.04%)、吃奶差(24.69%)、前囟张力增高(23.46%),早发型组(起病日龄≤出生后7 d)吃奶差的发生率高于晚发型组(起病日龄>出生后7 d)(P<0.05);检出病原菌以大肠埃希菌(E.coli)和B族链球菌(GBS)为主;E.coli组CSF葡萄糖含量比GBS组更低(P<0.05);CSF培养阳性尤其是CSF和血培养均阳性的新生儿CSF压力和蛋白含量均更高(均P<0.05);6例新生儿在起病24 h内行第1次腰椎穿刺术的结果为CSF白细胞数在正常范围内,其中4例新生儿在第1次腰椎穿刺术48~72 h后复查CSF白细胞数明显增高;79例新生儿完善了头颅MRI或CT检查,发现7例(8.86%)新生儿出现并发症,其中5例CSF和/或血液中检出病原菌。结论新生儿化脓性脑膜炎临床表现不典型,新生儿出现发热应引起高度的重视,即使CSF常规、生化正常也不能排除化脓性脑膜炎的诊断,应及时进行CSF复查检测。Objective To explore the clinical characteristics of neonatal purulent meningitis(NPM),and provide evidence for early diagnosis and treatment of NPM.Methods Clinical data of neonates who were hospitalized in a neonatal ward from January 1,2011 to December 31,2018 and was diagnosed with NPM when they were discharged from hospital were analyzed retrospectively,according to the number of days after birth at the time of disease onset and results of blood culture and cerebrospinal fluid(CSF)culture,they were divided into different groups,diffe-rences in clinical characteristics between different groups were compared.Results The first four clinical manifestations of 81 neonates were fever(88.89%),change in consciousness(37.04%),poor milk intake(24.69%),and increased tension in the anterior fontanelle(23.46%),incidence of poor milk intake in early-onset group(onset age≤7 days after birth)was higher than that in late-onset group(onset age>7 days after birth)(P<0.05);the main isolated pathogens were Escherichia coli(E.coli)and group B streptococcus(GBS);glucose content in CSF in E.coli group was lower than that in GBS group(P<0.05);neonates with positive CSF culture especially those with both positive CSF and blood culture had higher CSF pressure and CSF protein content(both P<0.05);six neonates showed that the number of CSF leukocytes was within the normal range after the first lumbar puncture within 24 hours after disease onset,4 of whom showed a significant increase in the number of CSF leukocytes at re-examination after 48-72 hours of the first lumbar puncture;79 neonates performed MRI or CT examination of the head,7 of whom(8.86%)were found to have complications,5 cases were found to have pathogens in CSF and/or blood.Conclusion Clinical manifestation of NPM is not typical,more attention should be paid to the fever of neonates,even if CSF is normal in routine and biochemical detection,diagnosis of purulent meningitis cannot be excluded,CSF re-examination should be performed timely.

关 键 词：新生儿 化脓性脑膜炎 病原菌 临床特征 

分 类 号：R722.13[医药卫生—儿科]