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新生儿化脓性脑膜炎临床特征分析
杜维纳,巨容,高淑强,王译,田欣
0
(成都市妇女儿童中心医院新生儿科,四川 成都 610031)
摘要:
目的 探讨新生儿化脓性脑膜炎的临床特征,为临床诊断与治疗提供指导。方法 收集成都市妇女儿童医学中心新生儿科2011年1月~2015年12月76例确诊化脓性脑膜炎患儿的病历资料,按胎龄分为足月儿组和早产儿组,对两组的临床特征进行对比分析。结果 足月儿组以发热(=6.94,P=0.045)、抽搐(=8.51,P=0.026)、肌张力异常(=9.63,P=0.021)为突出表现,而早产儿组则呼吸暂停表现突出(=10.57,P=0.014);两组患儿的脑脊液培养均以大肠埃希菌和无乳链球菌为主;足月儿组治愈患儿的住院时间为(25±4)d,早产儿组为(31±9)d;头颅核磁检查发现289%的患儿存在不同程度的脑损伤,两组患儿对比,早产患儿发生脑出血(=8.72,P=0.013)、脑白质异常信号改变(=10.24,P=0.01)和听觉诱发电位异常(=9.42,P=0.02)的机率更大。结论 新生儿化脓性脑膜炎临床表现不典型,对于不明原因或临床无法解释的发热和呼吸暂停患儿要高度警惕化脓性脑膜炎的可能,除大肠埃希菌外,无乳链球菌感染需高度警惕;新生儿化脓性脑膜炎治愈所需时间长,可能遗留不同程度的后遗症,早产患儿发生脑功能障碍及听力损伤的机率较足月患儿更大。
关键词:  新儿生  脑膜炎  细菌性  病原学诊断;预后
DOI:
基金项目:
Analysis of clinical feature of 76 newborns with purulent meningitis
DU Weina,JU Rong,GAO Shuqiang,WANG Yi,TIAN Xin
(Neonatology Departmant, Chengdu Central Hospital of Women and Children, Chengdu 610031, China)
Abstract:
Objective To investigate the clinical features of neonatal purulent meningitis and provide guidance for clinical diagnosis and treatment. Methods The clinical features of 76 patients diagnosed neonatal purulent meningitis from Chengdu Central Hospital of Women and Children between January 2011 and December 2015 were retrospectively analyzed. The patients, according to gestational age, were divided into full term group and preterm group. Results The main clinical manifestations of full term group were fever (chi square=6.94, P=0.045), convulsions (chi square=8.51, P=0.026) and abnormal muscle tone (chi square=9.63, P=0.021). The main clinical manifestations of preterm group were apnea outperform (chi square=10.57, P=0.014). The main bacteria of CSF cultures are Escherichia Coli and group B streptococcal. The treatment time of full term group and preterm group were 25±4 day and 31±9 day. According to Head MRI, 289% of children with different degree of brain injury was found. The premature children shown cerebral hemorrhage (chi square=8.72, P=0.013), cerebral white matter abnormalities signal change (chi square=10.24, P=0.01) and abnormal auditory evoked potential (chi square=9.42, P=0.02). Conclusion Clinical manifestations of neonatal purulent meningitis are not typical. The clinicians should be alert to the clinical children with unknown reasons or unexplained fever and apnea. E. coli, group B streptococcal infection should be on high alert. The neonatal purulent meningitis cure need long time, and maybe have different level sequelae, brain dysfunction and hearing loss occurs in premature children more possibility than full term children.
Key words:  Newborn  Purulent meningitis  Bacterial  Etiology diagnosis  Prognosis

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