新生儿真菌性脑膜炎15例临床特点分析  

Analysis of Clinical Characteristics of 15 Cases of Neonatal Fungal Meningitis

作　　者：李玲[1] 李贵南[1] 吴运芹[1] LI Ling;LI Guinan;WU Yunqin(Department of Neonatology,Children's Hospital of Hunan Province,Changsha Hunan 410007)

机构地区：[1]湖南省儿童医院新生儿科,湖南长沙410007

出　　处：《医学临床研究》2025年第2期189-192,共4页Journal of Clinical Research

基　　金：湖南省卫生健康委员会2022年度科研立项课题(202206034289)。

摘　　要：【目的】探讨新生儿真菌性脑膜炎的临床特点、诊疗及预后。【方法】回顾性分析2018年1月至2022年12月湖南省儿童医院新生儿科收治的15例真菌性脑膜炎患儿的临床资料,总结发病特点、临床表现、实验室检查、治疗及转归。【结果】15例真菌性脑膜炎病例中,早产儿11例(73.3%),超低出生体重儿1例(6.7%)、极低出生体重儿4例(26.7%)、低出生体重儿7例(46.7%),发病日龄≥9 d。15例患儿确诊前均曾使用广谱抗生素,接受经外周静脉穿刺的中心静脉导管(PICC)置管12例(80%)、静脉营养11例(73.3%)、有创呼吸机5例(33.3%),无创通气10例(66.7%)。15例患儿脑脊液真菌培养阳性10例,其中白色假丝酵母菌8例(53.3%)、近平滑假丝酵母菌1例,1例为真菌孢子(真菌类型不详);另5例根据血真菌培养阳性且脑脊液白细胞计数>20×10^(6)/L诊断。治疗上主要采用氟康唑、两性霉素B、氟胞嘧啶等抗感染治疗。治愈8例(53.3%)、好转5例(33.3%),死亡2例。【结论】新生儿真菌性脑膜炎常见于早产儿、低出生体重的患儿,主要继发于广谱抗生素的不合理应用及各项侵入性操作后,临床症状多与其他病原菌所致的颅内感染相似,氟康唑可为首选抗真菌药,疗效不佳时可选用两性霉素B联合氟胞嘧啶治疗。【Objective】To explore the clinical characteristics,diagnosis,treatment and prognosis of neonatal fungal meningitis.【Methods】A retrospective analysis was conducted on the clinical data of 15 neonates with fungal meningitis admitted to the Neonatal Department of Hunan Children's Hospital from January 2018 to December 2022.The onset characteristics,clinical manifestations,laboratory tests,treatment and prognosis were summarized.【Results】Among the 15 cases of neonatal fungal meningitis,11 cases were preterm infants(73.3%),1 case was extremely low birth weight infant(6.7%),4 cases were very low birth weight infants(26.7%),and 7 cases were low birth weight infants(46.7%).The age of onset was≥9 days.All 15 cases had received broad-spectrum antibiotics before diagnosis.Twelve cases(80%)received peripherally inserted central catheter(PICC)catheterization,11 cases(73.3%)received intravenous nutrition,5 cases(33.3%)received invasive mechanical ventilation,and 10 cases(66.7%)received non-invasive ventilation.Another 5 cases were diagnosed based on positive blood fungal culture and cerebrospinal fluid white blood cell count>20×10^(6)/L.The main treatment was antifungal therapy with fluconazole,amphotericin B,and flucytosine.Eight cases were cured(53.3%),five cases improved(33.3%),and two cases died.【Conclusion】Fungal meningitis in neonates is common in premature infants and low birth weight infants,mainly secondary to the irrational use of broad-spectrum antibiotics and various invasive procedures.The clinical symptoms are similar to those caused by other pathogenic bacteria.Fluconazole can be the first choice for antifungal drugs,and amphotericin B combined with flucytosine can be used when the treatment effect is poor.

关 键 词：脑膜炎 真菌性 婴儿 新生 预后 

分 类 号：R725.293[医药卫生—儿科]