摘要
目的分析新生儿难治性化脓性脑膜炎的临床特征,为临床诊治提供参考。方法回顾分析2015年4月至2016年10月山东大学儿童医院新生儿科收治的难治性化脓性脑膜炎患儿的病例资料,分析其围产期高危因素、临床表现、实验室检查、颅脑磁共振结果及治疗与预后。结果 20例患儿中,男11例(55%),女9例(45%),平均胎龄(39±1.42)周,平均出生体质量(3.16±0.67)kg,平均发病日龄(12.1±8.77)d。其中早期新生儿(<7 d)6例(30%),晚期新生儿(>7 d)14例(70%)。胎膜早破7例、羊水污染4例、母亲产前发热/感染2例。临床以发热、惊厥、反应差为主要临床表现,极少数除发热外无神经系统表现。脑脊液检查白细胞计数显著升高(>1000×106/L),糖明显降低(<1.0 mmol/L),蛋白含量增高(>2 g/L)。治疗过程中复查脑脊液细胞计数的降低快于糖的升高。病原学仍以大肠埃希菌感染最为常见,无乳链球菌感染有明显上升趋势。所有病例均有颅脑影像学异常改变,其中脑外间隙增宽为最常见表现,其次为脑积水。治疗上对美罗培南、万古霉素、利奈唑胺等强有力抗生素治疗效果尚可,40%患儿治愈出院,35%临床症状好转,5例患儿体温正常,脑脊液好转但未正常,家长因严重并发症自动出院。平均住院日达(39.68±13.09)d,平均住院费用达(41050±16529.24)元。结论新生儿难治性化脓性脑膜炎病例日益增多,其临床症状不典型,并发症多且重,治疗困难,住院时间长,花费高,预后不良。临床有反复发热,伴惊厥、反应差等临床症状患儿需极早行脑脊液检查;脑脊液细胞数>1000×106/L,糖<1.0 mmol/L,蛋白>2000 mg/L,血和(或)脑脊液培养阳性,颅脑MRI有异常者需警惕难治性脑炎。治疗上,碳氢酶烯类、万古霉素、利奈唑胺等强有力的抗生素为难治性脑炎的首选用药。
Objective To identify the clinical characteristics in neonatal refractory purulent meningitis. Methods Clinical data of 20 cases of neonatal refractory purulent meningitis admitted to the neonatal department at Jinan Children＇s Hospital from April 2015 to December 2016 were reviewed retrospectively. Analyze the high risk factors of perinatal period, clinical manifestation, laboratory examination, brain MRI characteristics, treatment and prognosis. Resaults There are 11 boys and 9 girls among the 20 cases, the average gestation is（39±1.42） weeks, average birthweight is（3.16±0.67） kg, and the average onset of disease is（12.1±8.77） days. 7 babies have premature rupture of membranes, 4 babies have amniotic fluid pollution, and 2 baby＇s mother have prenatal infection. Fever, seizure, and low response are the most common clinical manifestation, very few babies only have fever but not nervous system features. There are high white blood cell count（1000×106/L）, high protein concentration（2 g/L） and low glucose concentration（1.0 mmol/L） of cerebrospinal fluid. Escherichia coli is still the most common etiology, the infection of Streptococcus agalactiae becomes more and more. Abnormal brain MRI findings can be found in every case, intracranial extracerebral space abnormality is the most common findings, and secondly is hydrocephalus. Meropenem, vancomycin, and linezolid are still curative. They need spend long time and large money for the diease. Conclusion Neonatal refractory purulent meningitis have became more and more. It＇s clinical manifestation is not typical. It has many serious complications and is hard to deal with. If a baby has prolonged fever, seizure, low response, he/she need a cerebrospinal fluid examination as soon as possible. Hige white blood cell count, high protein concentratioe, low CSF glucose concentration, positive CSF/blood culture results and abnormal brain MRI findings are more likely to have refractory purulent meningitis. Meropenem, vancomycin, and linezolid are the first choice for refractory purulent meningitis.
出处
《中国医药指南》
2018年第1期14-15,18,共3页
Guide of China Medicine
关键词
新生儿
脑膜炎
脑脊液
大肠埃希菌
无乳链球菌
Neonatal
Meningitis
Cerebrospinal fluid
Escherichia coli
Streptococcus agalactiae
