不同病原菌化脓性脑膜炎患儿的临床特点对比分析  

Comparative analysis of clinical characteristics of neonates with purulent meningitis caused by different pathogens

作　　者：陈志卿[1] 周丹 林芳芳[1] CHEN Zhi-qing;ZHOU Dan;LIN Fang-fang(Department of Neonatology,Fujian Maternity and Child Health Hospital,Fujian Province,Fuzhou350001,China)

机构地区：[1]福建省妇幼保健院新生儿科,福建福州350001

出　　处：《中国当代医药》2020年第30期13-17,共5页China Modern Medicine

摘　　要：目的探讨新生儿不同病原菌化脓性脑膜炎的临床特点、病原菌分布、治疗及转归,为临床合理治疗提供依据。方法回顾性分析2014年1月1日~2016年12月31日福建省妇幼保健院收治的134例化脓性脑膜炎患儿的病例资料,根据血培养或脑脊液培养结果将研究对象分为无乳链球菌(GBS)组15例、其他细菌组14例,病原菌不明组105例,比较各组的临床特征。结果新生儿化脓性脑膜炎以发热、呼吸急促、黄疸反复为主要临床表现,发热最常见。血液和脑脊液培养阳性率较低,以GBS、大肠埃希菌为主。GBS组、其他细菌组的C反应蛋白(CRP)水平高于病原菌不明组,差异有统计学意义(P<0.05)。其他细菌组、GBS组的脑脊液白细胞计数高于病原菌不明组,GBS组的脑脊液多核细胞百分比高于其他细菌组、病原菌不明组,差异均有统计学意义(P<0.05)。脑脊液蛋白>1.88 g/L有30例,其中出现并发症13例。治愈83例,好转44例,2例并发硬膜下积液转神经外科进一步治疗,5例因严重并发症放弃治疗。结论新生儿化脓性脑膜炎临床表现缺乏特异性,发热为最常见症状;病原菌以GBS、大肠埃希菌为主;CRP明显升高,脑脊液白细胞数及多核细胞百分比升高者应考虑GBS感染。Objective To study the clinical characteristics,pathogen distribution,treatment and outcome of purulent meningitis in neonates in order to provide the guide for early diagnosis and appropriate treatment.Methods The case data of 134 newborn children with purulent meningitis who were admitted to Fujian Maternity and Child Health Hospital from January 1,2014 to December 31,2016 were retrospectively analyzed.According to the results of blood culture or cerebrospinal fluid(CSF)culture,the subjects were divided into the Streptococcus agalactiae(GBS)group(15 cases),the other bacteria group(14 cases),and the unknown pathogen group(105 caces),and the clinical characteristics of each group were compared.Results The main clinical manifestations of purulent meningitis were fever,shortness of breath and jaundice,fever was the most common symptom.The positive rate of blood and cerebrospinal fluid culture was low,mainly GBS and Escherichia coli.C-reactive protein(CRP)levels in the GBS group and the other bacteria group were higher than those in the unknown pathogen group,and the differences were statistically significant(P<0.05).The cerebrospinal fluid white blood cell counts of the other bacteria group and the GBS group were higher than those of the unknown pathogen group,the percentage of CSF polykaryotic cells in the GBS group was higher than that in the other bacteria group and the unknown pathogen group,and the differences were statistically significant(P<0.05).There were 30 cases with CSF protein exceeding 1.88 g/L,among whom 13 cases had complications.A total of 83 cases were cured,44 cases were improved,2 cases were complicated with subdural effusion for further treatment by neurosurgery,and 5 cases were abandoned due to severe complications.Conclusion The clinical manifestations of neonatal purulent meningitis are lack of specificity,fever is the most common symptom.The main pathogens are GBS and Escherichia coli,and GBS infection should be considered if CRP,the percentage of leukocytes and polynuclear cells in CSF inc

关 键 词：脑膜炎 细菌性 新生儿 病原学 治疗结果 

分 类 号：R722.13[医药卫生—儿科]