中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2014年
9期
569-573
,共5页
流行性脑脊髓膜炎%脑膜炎奈瑟菌%儿童%危险因素
流行性腦脊髓膜炎%腦膜炎奈瑟菌%兒童%危險因素
류행성뇌척수막염%뇌막염내슬균%인동%위험인소
Epidemic cerebrospinal meningitis%Neisseria meningitides%Children%Risk factors
目的 提高临床儿科医生对儿童流行性脑脊髓膜炎的诊治水平.方法 回顾性分析本院1999年至2011年收治的69例儿童流行性脑脊髓膜炎的发病时间、发病年龄、临床表现、实验室检查、治疗经过及预后情况.同时按类型把该组病例分为普通型和暴发型,进行危险因素分析.结果 发病年龄56 d ～15岁,平均(6.85±5.12)岁,其中＜6个月7例,～5岁30例,～10岁9例,≥10岁23例.男33例,女36例.发病时间1～5月份60例,6～10月份6例,11 ～ 12月份3例.普通型42例,全部治愈出院;暴发型27例,有7例死亡.所有患儿均急性起病伴有发热,皮肤瘀点瘀斑92.75％,头痛52.17％,呕吐71.01％,颈抵抗阳性94.20％,惊厥21.74％,嗜睡或昏迷50.72％,病理征阳性46.38％,血压下降、休克表现34.78％.血常规白细胞计数升高63.77％,下降8.70％;血小板计数下降42.03％;55.07％患儿有电解质紊乱;89,86％患儿有凝血功能异常,其中纤维蛋白原下降46.38％.皮疹印片和脑脊液涂片革兰染色检出革兰阴性双球菌阳性率分别为12.5％ (8/64)和19.35％ (12/62);脑脊液培养阳性率为12.90％(8/62),血培养阳性率为7.25％(5/69).药敏显示青霉素、头孢曲松对细菌敏感.发病年龄、白细胞计数下降、血小板计数下降、纤维蛋白原下降、意识改变等指标在普通型和暴发型差异有统计学意义(P＜0.05).结论 儿童流行性脑脊髓膜炎发病时间集中在1～5月份,年龄以5岁以下为主,儿童流行性脑脊髓膜炎的抗菌药首选青霉素和(或)头孢曲松,发病年龄、血小板计数下降、白细胞计数下降、纤维蛋白原下降、意识改变等指标可作为儿童流行性脑脊髓膜炎的危险因素推测病情的严重程度.
目的 提高臨床兒科醫生對兒童流行性腦脊髓膜炎的診治水平.方法 迴顧性分析本院1999年至2011年收治的69例兒童流行性腦脊髓膜炎的髮病時間、髮病年齡、臨床錶現、實驗室檢查、治療經過及預後情況.同時按類型把該組病例分為普通型和暴髮型,進行危險因素分析.結果 髮病年齡56 d ～15歲,平均(6.85±5.12)歲,其中＜6箇月7例,～5歲30例,～10歲9例,≥10歲23例.男33例,女36例.髮病時間1～5月份60例,6～10月份6例,11 ～ 12月份3例.普通型42例,全部治愈齣院;暴髮型27例,有7例死亡.所有患兒均急性起病伴有髮熱,皮膚瘀點瘀斑92.75％,頭痛52.17％,嘔吐71.01％,頸牴抗暘性94.20％,驚厥21.74％,嗜睡或昏迷50.72％,病理徵暘性46.38％,血壓下降、休剋錶現34.78％.血常規白細胞計數升高63.77％,下降8.70％;血小闆計數下降42.03％;55.07％患兒有電解質紊亂;89,86％患兒有凝血功能異常,其中纖維蛋白原下降46.38％.皮疹印片和腦脊液塗片革蘭染色檢齣革蘭陰性雙毬菌暘性率分彆為12.5％ (8/64)和19.35％ (12/62);腦脊液培養暘性率為12.90％(8/62),血培養暘性率為7.25％(5/69).藥敏顯示青黴素、頭孢麯鬆對細菌敏感.髮病年齡、白細胞計數下降、血小闆計數下降、纖維蛋白原下降、意識改變等指標在普通型和暴髮型差異有統計學意義(P＜0.05).結論 兒童流行性腦脊髓膜炎髮病時間集中在1～5月份,年齡以5歲以下為主,兒童流行性腦脊髓膜炎的抗菌藥首選青黴素和(或)頭孢麯鬆,髮病年齡、血小闆計數下降、白細胞計數下降、纖維蛋白原下降、意識改變等指標可作為兒童流行性腦脊髓膜炎的危險因素推測病情的嚴重程度.
목적 제고림상인과의생대인동류행성뇌척수막염적진치수평.방법 회고성분석본원1999년지2011년수치적69례인동류행성뇌척수막염적발병시간、발병년령、림상표현、실험실검사、치료경과급예후정황.동시안류형파해조병례분위보통형화폭발형,진행위험인소분석.결과 발병년령56 d ～15세,평균(6.85±5.12)세,기중＜6개월7례,～5세30례,～10세9례,≥10세23례.남33례,녀36례.발병시간1～5월빈60례,6～10월빈6례,11 ～ 12월빈3례.보통형42례,전부치유출원;폭발형27례,유7례사망.소유환인균급성기병반유발열,피부어점어반92.75％,두통52.17％,구토71.01％,경저항양성94.20％,량궐21.74％,기수혹혼미50.72％,병리정양성46.38％,혈압하강、휴극표현34.78％.혈상규백세포계수승고63.77％,하강8.70％;혈소판계수하강42.03％;55.07％환인유전해질문란;89,86％환인유응혈공능이상,기중섬유단백원하강46.38％.피진인편화뇌척액도편혁란염색검출혁란음성쌍구균양성솔분별위12.5％ (8/64)화19.35％ (12/62);뇌척액배양양성솔위12.90％(8/62),혈배양양성솔위7.25％(5/69).약민현시청매소、두포곡송대세균민감.발병년령、백세포계수하강、혈소판계수하강、섬유단백원하강、의식개변등지표재보통형화폭발형차이유통계학의의(P＜0.05).결론 인동류행성뇌척수막염발병시간집중재1～5월빈,년령이5세이하위주,인동류행성뇌척수막염적항균약수선청매소화(혹)두포곡송,발병년령、혈소판계수하강、백세포계수하강、섬유단백원하강、의식개변등지표가작위인동류행성뇌척수막염적위험인소추측병정적엄중정도.
Objective To improve the diagnosis and treatment of epidemic cerebrospinal meningitis in children.Methods A retrospective review was performed and a total of 69 cases of children epidemic cerebrospinal meningitis were collected and classified into ordinary and fulminant epidemic cerebrospinal meningitis from 1999 to 2011.Disease prevalent season,age,clinical characteristics,laboratory examination,treatment,prognosis and risk factors were analyzed.Results The mean age(33 male and 36 female) was (6.85 ±5.12)years old,ranging from 56 days to 15 years old.A total of 60 cases began on January to May; 6 cases began on June to October; 3 cases began on November to December.All of the 42 cases of ordinary epidemic meningitis were recovered; 7 cases of fulminant epidemic meningitis(n =27) were dead.All of the patients had fever; 64 cases(92.75％) had Petechiae petechial skin; 36 cases(52.17％) had headache; 49 cases(71.01％) vomited; 65 cases(94.2％) had positive neck resistance; 15 cases(21.74％) had convulsion; 35 cases(50.72％) had drowsiness or coma; 32 cases (46.38％) had positive pathological signs and 24 cases (34.78％) had low blood pressure or shock.Blood tests revealed that 63.77％ of the patients leukocytes raised and 8.70％ of the patients reduced; 42.03％ of the patients platelet reduced; 55.07％ of the patients had electrolyte disturbance and 89.86％ of the patients had coagulation disorders,among which 46.38％ fibrinogen reduced.The rash printed piece and cerebrospinal fluid smear tests found that Gram-negative bacteria positive rate were 12.5％ and 19.35％ respectively; the positive rate in bacterial culture of cerebrospinal fluid and blood culture were 12.90％ and 7.25％ respectively.Drug sensitive test showed that penicillin and ceftriaxone were sensitive to bacteria.The differences of age,leukocyte and platelet counts,fibrinogen and altered mental status between ordinary and fluminant epidemic meningitis were significant (P ＜ 0.05).Conclusion The prevalent season is from January to May and the prevalent age is less than 5 years for children with epidemic cerebrospinal meningitis.Ceftriaxone or penicillin should be the preferred choice;age,lower leukocyte and platelet counts,lower fibrinogen and altered mental status should be used to predict the severity of the disease.
