新生儿化脓性脑膜炎死亡病例的临床分析  

Clinical analysis of death cases of neonatal purulent meningitis

作　　者：易娟 张榕[1] 彭小明[1] YI Juan;ZHANG Rong;PENG Xiaoming(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》2024年第1期37-43,共7页Journal of Epileptology and Electroneurophysiology(China)

摘　　要：目的探讨新生儿化脓性脑膜炎(NPM)导致死亡结局病例的临床特征,提高对该病死亡风险的认知。方法回顾性收集2019年6月至2023年6月湖南省儿童医院新生儿科收治的20例NPM死亡病例的资料,对其临床表现、检验结果、病原学及影像学特征等进行分析,按患儿起病年龄及胎龄分组,比较不同组新生儿NPM临床特点的差异。结果本研究期间共收治653例NPM患儿,其中出现死亡结局的患儿共20例(3.1%),其血感染指标如白细胞、C反应蛋白(CRP)、降钙素原(PCT)、血小板、脑脊液(CSF)白细胞数、糖及蛋白均明显异常。其中血培养阳性14例,CSF培养阳性10例,病原菌以无乳链球菌(GBS)及大肠埃希菌(E-coli)为主。15例患儿完善颅脑MRI+增强+DWI,均有脑膜强化及脑水肿,5例合并脑疝。20例患儿均完善振幅整合脑电图(aEEG)检查,其中15例为重度改变。早发型组患儿的CSF白细胞数高于晚发型组,早产儿组起病年龄大于足月儿组。结论病原菌为GBS、E-coli的NPM死亡风险高,需早期识别、尽早使用有效抗生素,尽量避免不良结局的发生,并积极完善影像学及aEEG检查判断预后。Objective To investigate the clinical characteristics of fatal cases of neonatal purulent meningitis(NPM)to raise awareness of the risk of death from this disease.Methods Retrospective data was collected from 20 cases of NPM mortality in the Department of Neonatology at Hunan Children's Hospital from June 2019 to June 2023.Clinical manifestations,test results,pathogeny and imaging features were analyzed.The differences in clinical characteristics of NPM in neonates were compared based on the age of onset and gestational age of the children.Results During the study period,653 NPM cases were admitted,among which,there were 20 cases with fatal outcomes(3.1%).Blood infection indicators such as leukocytes,C-reactive protein(CRP),procalcitonin(PCT),platelets,cerebrospinal fluid(CSF),leukocyte count,glucose and protein were significantly abnormal.Among them,14 cases were positive in blood culture and 10 cases were positive in CSF culture,with the main pathogens being group B Streptococcus(GBS)and Escherichia coli(E-coli).Among 15 cases,who underwent comprehensive cranial MRI+enhancement+DWI,all showed meningeal enhancement and cerebral edema,and 5 cases had brain herniation.All 20 cases underwent comprehensive monitoring with Amplitude-Integrated Electroencephalography(aEEG),with 15 cases showing severe abnormalities.Leukocyte number in CSF in the early-onset group was higher than that in the late-onset group,and the onset age in the premature group was older than that in the full-term group.Conclusion NPM with GBS and E.coli as pathogens has a high risk of death,requiring early identification,prompt use of effective antibiotics and efforts to avoid adverse outcomes.It is also important to actively improve imaging and aEEG examinations to assess prognosis.

关 键 词：新生儿 化脓性脑膜炎 死亡 无乳链球菌 大肠埃希菌 

分 类 号：R722.1[医药卫生—儿科] R512.3[医药卫生—临床医学]