新生儿化脓性脑膜炎的临床诊治分析  

Clinical diagnosis and treatment of neonatal suppurative meningitis

作　　者：赵慧 朱雪萍[1] ZHAO Hui;ZHU Xue-ping(Department of Neonatology,Children's Hospital Affiliated to Soochow University,Suzhou 215002,China)

机构地区：[1]苏州大学附属儿童医院新生儿科,215002

出　　处：《中国实用医药》2024年第19期42-44,共3页China Practical Medicine

摘　　要：目的 分析新生儿化脓性脑膜炎的临床特点及诊治方案。方法 回顾性分析226例新生儿化脓性脑膜炎患儿的临床资料,观察总结患儿出生情况、入院基本表现、临床表现、实验室检查结果、治疗过程、预后情况。结果 226例患儿中早产76例(33.63%),足月分娩150例(66.37%);剖宫产69例(30.53%),阴道分娩157例(69.47%)。患儿入院表现为发热146例(64.60%),面苍63例(27.88%),激惹59例(26.11%)。患儿临床表现以黄疸为主(52.21%),其次为气促(46.90%)、反应差(45.13%)。外周血常规白细胞计数>20×10^(9)/L的占比最高,达41.59%,其次为(10~20)×10^(9)/L,达30.09%;脑脊液检查中糖定量下降、氧化物下降、蛋白定量升高占比均较高,分别为83.19%、79.20%、89.38%;脑脊液细菌培养阳性占比为27.88%。226例患儿均经抗生素治疗,治疗后痊愈出院1例,好转出院213例,死亡、放弃9例,其他3例。结论 新生儿化脓性脑膜炎无典型性临床表现,且与患儿分娩方式、是否足月均无明显关系,其可基于败血症和细菌侵入脑膜而引发疾病;该病症临床症状、体征均无特异性,诊断需依靠临床观察、脑脊液检查与血培养结果,根据临床检查结果合理选择抗生素,积极护理是提升治疗效果的关键。Objective To analyze the clinical features,diagnosis and treatment of neonatal suppurative meningitis.Methods The clinical data of 226 cases of neonatal purulent meningitis children were retrospectively analyzed,and the birth situation,basic admission performance,clinical manifestations,laboratory test results,treatment process and prognosis of the children were observed and summarized.Results Among the 226 neonates,76 cases(33.63%)of preterm delivery and 150 cases(66.37%)of full-term delivery;there were 69 cases(30.53%)of cesarean section and 157 cases(69.47%)of vaginal delivery.Children were admitted with presentation of fever in 146 cases(64.60%),pallor in 63 cases(27.88%)and agitation in 59 cases(26.11%).Clinical manifestations of the children were predominantly jaundice(52.21%)followed by shortness of breath(46.90%)and poor response(45.13%).The percentage of peripheral blood leukocyte count>20×10^(9)/L was the highest at 41.59%,followed by(10-20)×10^(9)/L at 30.09%.In cerebrospinal fluid examination,the percentages of decreased sugar quantification,decreased oxide,and elevated protein quantification were high,with 83.19%,79.20%,and 89.38%,respectively;the percentage of positive cerebrospinal fluid bacterial culture was 27.88%.After antibiotic treatment of 226 neonates,1 case was cured and discharged from hospital,213 cases of improvement,9 cases of death and abandonment,and 3 other cases.Conclusion There is no typical clinical manifestation of neonatal suppurative meningitis,and there is no significant correlation with delivery mode and term.It can be based on septicaemia,where bacteria invade the meninges and cause disease.The clinical symptoms and signs of this disease are non-specific,and the diagnosis depends on clinical observation,cerebrospinal fluid examination and blood culture results.The reasonable selection of antibiotics and active nursing according to the clinical examination results are the key to improve the treatment effect.

关 键 词：新生儿化脓性脑膜炎 疾病特点 诊治方案 抗生素 

分 类 号：R722.1[医药卫生—儿科] R742.9[医药卫生—临床医学]