新生儿化脓性脑膜炎的临床特点、病原菌分布及预后影响因素分析  

Clinical characteristics,pathogen distribution,and prognostic factors of neonatal purulent meningitis

作　　者：任荣 白亚飞[1] 罗少龙 REN Rong;BAI Ya-fei;LUO Shao-long(Department of Neonatology,Baoji Maternal and Child Health Care Hospital,Baoji 721000,Shaanxi,CHINA)

机构地区：[1]宝鸡市妇幼保健院新生儿科,陕西宝鸡721000

出　　处：《海南医学》2022年第21期2798-2801,共4页Hainan Medical Journal

基　　金：陕西省自然科学基金(编号:2012C21)。

摘　　要：目的分析新生儿化脓性脑膜炎的临床特点、病原菌分布及预后影响因素。方法回顾性分析2016年1月至2020年1月宝鸡市妇幼保健院收治的90例新生儿化脓性脑膜炎的临床资料,根据随访1年后预后情况将患儿分为预后良好组74例和预后不良组16例,比较两组患儿的临床特征、病原菌分布及实验室指标,采用多元Logistic回归分析其预后影响因素。结果预后良好组患儿表现为少动17例(22.97%)、黄疸20例(27.03%)、前囟张力增高16例(21.62%)、呼吸不规则10例(13.51%)、发热46例(62.16%)、吃奶差33例(44.59%),预后不良组新生儿表现为少动10例(62.50%)、黄疸4例(25.00%)、前囟张力增高8例(50.00%)、呼吸不规则3例(18.75%)、发热11例(68.75%)、吃奶差6例(37.50%),预后不良组新生儿少动、前囟张力增高者的比率明显高于预后良好组,差异均有统计学意义(P<0.05);两组患儿的革兰氏阴性细菌和革兰氏阳性细菌比较差异均无统计学意义(P>0.05);预后不良组患儿脑脊液总蛋白含量、白细胞水平、丙二醛(MDA)浓度分别为(1.89±0.45)g/L、(3.64±0.85)×10^(9)/L、(8.24±2.56)μmol/L,明显高于预后良好组的(1.13±0.34)g/L、(2.27±0.63)×10^(9)/L、(6.25±1.94)μmol/L,脑脊液糖浓度为(1.36±0.37)mmol/L,明显低于预后良好组的(2.03±0.52)mmol/L,差异均有统计学意义(P<0.05);经多元Logistic回归分析结果显示,前囟张力增高、脑脊液总蛋白含量、脑脊液糖浓度、MDA浓度是影响新生儿化脓性脑膜炎预后的独立危险因素(P<0.05)。结论少动、前囟张力增高等症状不利于新生儿化脓性脑膜炎预后恢复,其致病菌以大肠埃希菌等革兰阴性菌为主,前囟张力增高、脑脊液总蛋白含量、脑脊液糖浓度、MDA浓度是影响新生儿化脓性脑膜炎预后的独立危险因子。Objective To analyze the clinical characteristics,pathogen distribution,and prognostic factors of neonatal purulent meningitis.Methods Retrospective analysis was performed on the clinical data of 90 neonates with purulent meningitis admitted to Baoji Maternal and Child Health Care Hospital between January 2016 and January 2020.According to the prognosis after one year of follow-up,the children were divided into good prognosis group(74 cases)and poor prognosis group(16 cases).The clinical characteristics,pathogen distribution,and laboratory indexes of the two groups were compared and analyzed.Multivariate regression analysis was used to analyze the prognostic factors.Results The neonates showed neonatal hypomotility in 17 cases(22.97%),icterus in 20 cases(27.03%),increased bregma tension in 16 cases(21.62%),irregular breathing in 10 cases(13.51%),fever in 46 cases(62.16%),and poor milk intake in 33 cases(44.59%)in good prognosis group,versus 10 cases(62.50%),4 cases(25.00%),8 cases(50.00%),3 cases(18.75%),11 cases(68.75%),in 6 cases(37.50%)in poor prognosis group,respectively.The proportions of patients with neonatal hypomotility and increased bregma tension in poor prognosis group were significantly higher than those in good prognosis group(P<0.05).There was no statistically significant difference in Gram-negative bacteria and Gram-positive bacteria between the two groups(P>0.05).The total protein content of cerebrospinal fluid,leukocyte level,and malondialdehyde(MDA)were(1.89±0.45)g/L,(3.64±0.85)×10^(9)/L,and(8.24±2.56)μmol/L in poor prognosis group,significantly higher than(1.13±0.34)g/L,(2.27±0.63)×10^(9)/L,and(6.25±1.94)μmol/L in good prognosis group,while the concentrations of cerebrospinal fluid glucose was(1.36±0.37)mmol/L,significantly lower than(2.03±0.52)mmol/L in good prognosis group(P<0.05).Multivariate logistic regression analysis showed that increased bregma tension,total protein content of cerebrospinal fluid,cerebrospinal fluid glucose,and MDA concentration were independent risk factor

关 键 词：新生儿 化脓性脑膜炎 临床特点 病原菌 预后 影响因素 

分 类 号：R722.1[医药卫生—儿科]