首次腰穿检查脑脊液细胞数正常的儿童化脓性脑膜炎临床分析  

Purulent Meningitis in Children with Normal Cerebrospinal Fluid Cell Count During the First Lumbar Puncture

作　　者：魏烁瑾 王建东 靳培娜 谢垒[1] 方敩 禚志红[1] 王怀立[1] WEI Shuojin;WANG Jiandong;JIN Peina;XIE Lei;FANG Xiao;ZHUO Zhihong;WANG Huaili(Pediatric Intensive Care Unit,the First Affiliated Hospital of Zhengzhou Univerisity,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院儿童重症医学科,河南郑州450052

出　　处：《河南医学研究》2021年第2期200-203,共4页Henan Medical Research

摘　　要：目的探讨首次腰穿检查脑脊液细胞数正常的儿童化脓性脑膜炎(PM)的临床特征及预后转归。方法回顾性分析2013年1月至2019年8月在郑州大学第一附属医院确诊的17例首次腰穿检查脑脊液细胞数正常的儿童PM的临床资料,并对预后进行随访。结果17例患儿首次脑脊液检查细胞数均正常,其中7例(41.2%)脑脊液蛋白升高,11例(64.7%)脑脊液糖降低,5例(29.4%)脑脊液葡萄糖/血清葡萄糖比值降低,7例(41.2%)脑脊液蛋白升高同时伴脑脊液糖下降,4例(23.5%)脑脊液乳酸增高。16例患儿接受第2次腰穿检查,其中10例(62.5%)脑脊液细胞数升高。3例(17.6%)单纯血培养可见肺炎链球菌、革兰阳性菌、屎肠球菌,2例(11.8%)单纯脑脊液培养可见屎肠球菌、微球菌属,1例(5.9%)脑脊液革兰染色可见双球菌属。7例(58.3%)头颅影像学检查异常。3例(17.6%)失访,2例(11.8%)死亡,1例(5.9%)语言、运动发育落后,余11例(64.7%)痊愈。结论儿童PM脑脊液改变可不典型,首次脑脊液检查细胞数正常不能排除PM,需根据血液、脑脊液生化及细菌培养结果协助诊断,同时结合病情需尽早接受第2次腰穿检查,以早期明确诊断。Objective To explore the clinical features and prognostic outcome of purulent meningitis(PM)in children with normal cerebrospinal fluid cell count during the first lumbar puncture.Methods The data of 17 children with PM diagnosed in the First Affiliated Hospital of Zhengzhou University from January 2013 to August 2019 were retrospectively analyzed,and the prognosis was followed up.Results The number of cells in the first cerebrospinal fluid examination of 17 children was normal,of which 7 cases(41.2%)with increased cerebrospinal fluid protein,11 cases(64.7%)with decreased cerebrospinal fluid glucose,5 cases(29.4%)with cerebrospinal fluid glucose/serum glucose ratio decreased,7 cases(41.2%)with increased cerebrospinal fluid protein and decreased cerebrospinal fluid sugar,and 4 cases(23.5%)with increased cerebrospinal fluid lactate.Sixteen children underwent the second lumbar puncture examination,of which 10 cases(62.5%)with the increased number of cerebrospinal fluid cells.Three cases(17.6%)showed Streptococcus pneumoniae,Gram-positive bacteria,and Enterococcus faecium in simple blood culture,2 cases(11.8%)showed Enterococcus faecium and Micrococcus spp in cerebrospinal fluid culture alone,and 1 case(5.9%)showed dicoccus by Gram staining in cerebrospinal fluidand.Seven cases(58.3%)with abnormal head imaging.Three cases(17.6%)were lost to follow-up,2 cases(11.8%)died,1 case(5.9%)with poor language and motor development,and the remaining 11 cases(64.7%)were recovered.Conclusion The changes of cerebrospinal fluid in children with PM may not be typical.The normal cell count of the first cerebrospinal fluid examination can not exclude PM.The diagnosis should be assisted based on the results of blood,cerebrospinal fluid biochemistry and bacterial culture,and the second lumbar puncture should be received as soon as possible in combination with the condition.

关 键 词：化脓性脑膜炎 儿童 脑脊液细胞数 诊断 

分 类 号：R725.1[医药卫生—儿科]