新生儿难治性化脓性脑膜炎的临床特点分析  

Clinical characteristics of refractory pyogenic meningitis in neonates

作　　者：李笑[1] 彭小明[1] 颜卫群[1] 黄维清 肖勇[1] 张帆[1] LI Xiao;PENG Xiaoming;YAN Weiqun(Department of Neonatology,Hunan Children's Hospital,Changsha(410007),Hunan China)

机构地区：[1]湖南省儿童医院新生儿科,湖南长沙410007

出　　处：《癫痫与神经电生理学杂志》2020年第6期356-360,共5页Journal of Epileptology and Electroneurophysiology(China)

摘　　要：目的:探讨新生儿难治性化脓性脑膜炎的临床特征。方法:回顾性分析2018年5月至2019年5月湖南省儿童医院新生儿科收治的90例新生儿化脓性脑膜炎患儿的临床资料(一般资料、临床症状、实验室检查、治疗经过、头颅MRI、BAEP、眼底检查、脑电图等)。根据新生儿难治性化脓性脑膜炎诊断标准分为观察组28例(诊断为新生儿难治性化脓性脑膜炎)及对照组62例(新生儿化脓性脑膜炎)。采用/检验、秩和检验、^检验进行统计学分析。对新生儿难治性化脓性脑膜炎的相关影响因素采用Logistic回归分析。结果:①两组患儿发热、前囟饱满、外周白细胞异常、血小板降低、C-反应蛋白升高结果比较差异无统计学意义(P>0.05)。两组患儿惊厥、脑脊液白细胞计数增多、脑脊液蛋白含量增高、脑脊液糖含量降低、脑脊液和(或)血培养阳性比较差异有统计学意义(P<0.05);②发生惊厥、脑脊液糖含量降低、脑脊液蛋白含量增高、脑脊液和(或)血培养阳性是新生儿难治性化脓性脑膜炎的独立危险因素(P<0.05)。脑脊液白细胞计数增多是新生儿难治性化脓性脑膜炎的非独立危险因素(P>0.05);③两组患儿在视觉损伤结果方面比较差异无统计学意义;④在住院时间、听力损伤、脑电图异常结果方面比较差异有统计学意义(P<0.05)。结论:对于新生儿化脓性脑膜炎患儿,如病程中发生惊厥、脑脊液糖含量明显降低、脑脊液蛋白含量明显增高、脑脊液和(或)血培养阳性时,需考虑发生难治性化脓性脑膜炎可能。难治性化脓性脑膜炎出现听力损伤及脑电图异常比例高,预后相对较差。Objective:To investigate the clinical characteristics of neonates with refractory suppu­rative meningitis.Methods:Clinical data(general data,clinical symptoms,laboratory examination,treatment.head MRl,BAEP.fundus examination,electroencephalogram,etc.)of 90 neonates with suppurative meningitis from May 2018 to May 2019 were retrospectively analyzed.According to the diagnostic criteria of neonatal refractory suppurative meningitis,28 cases were divided into the obser­vation group(with neonatal refractory meningitis),while 62 cases were selected as the control group.T test,rank sum test and chi-square test were used for statistical analysis.Logistic regression was used to analyze the influencing factors of refractory suppurative meningitis of neonates.Results:(I)There was no statistically significant difference in fever,anterior fontanelle.abnormal peripheral leu­kocyte,thrombocytopenia,and c-reactive protein elevation between the two groups(P>0.05).There was statistically significant difference between the two groups in terms of convulsion,cerebro­spinal fluid white blood cell count,CSF protein content,CSF sugar content and CSF/blood culture positive(P<0.05).(2)Convulsion,decreased CSF sugar content,increased CSF protein content and positive brain/blood culture were independent risk factors for refractory suppurative meningitis(P<0.05).Increased white blood cell count in cerebrospinal fluid is an independent risk factor for refractory suppurative meningitis of neonates(P>0.05).(3)There was no statistically significant difference in visual impairment between the two groups;(4)There was statistically significant difference in length of hospital stay,hearing impairment,and abnormal EEG images.Conclusion:In the prognosis of chil­dren with purulent meningitis,if convulsions occur,the cerebrospinal fluid sugar content is signifi­cantly reduced»the cerebrospinal fluid protein content obviously increavsed and the brain/blood culture is positive,the possibility of refractory purulent meningitis should be considered.I

关 键 词：难治性化脓性脑膜炎 脑脊液 大肠埃希菌 

分 类 号：R722[医药卫生—儿科] R512.3[医药卫生—临床医学]