实用临床医学
實用臨床醫學
실용림상의학
Practical Clinical Medicine
2015年
9期
57-60
,共4页
细菌性脑膜炎%临床特点%新生儿
細菌性腦膜炎%臨床特點%新生兒
세균성뇌막염%림상특점%신생인
bacterial meningitis%clinical characteristics%newborns
目的：研究新生儿细菌性脑膜炎的发病人群、临床表现、实验室检查及转归的特点。方法采用回顾性分析法分析99例确诊为新生儿细菌性脑膜炎患儿的临床病历资料，对其临床表现、实验室检查结果、头颅影像学检查情况及临床转归进行分析。结果99例患儿中，＜7 d 发病占29．29％，农村患儿占62．63％，早产儿占17．17％；临床表现为反应差的患儿占82．83％，体温大于38．5℃占67．68％，肌张力改变占44．44％，惊厥占29．29％，原始反射减弱占40．40％。初次外周血感染指标检查结果和脑脊液（CSF）检查阳性率均不高，其中外周血 C-反应蛋白（CRP）异常率稍高于外周血白细胞计数异常率，但差异无统计学意义（45．46％比38．38％，P ＞0．05）；外周血降钙素原（PCT）与 CRP 异常率有明显差异（70．00％比50．50％，P ＜0．05）。从血液和 CSF 培养出的各种致病菌中， G－菌稍多于 G＋菌，血培养阳性率为26．26％，G－菌占53．85％，其中10例（38．46％）为多重耐药菌。脑脊液培养阳性率为11．11％，G－菌占54．55％，其中5例（45．45％）为多重耐药菌。80例患儿行头颅 CT 或 MRI 检查，异常头颅 CT 及 MRI 患儿占28．75％（23／80）。结论新生儿细菌性脑膜炎的临床表现无特异性，早期诊断较困难。对该病的早期诊断依赖于临床 PCT、CRP、血培养以及脑脊液等多项检验的联合判定。
目的：研究新生兒細菌性腦膜炎的髮病人群、臨床錶現、實驗室檢查及轉歸的特點。方法採用迴顧性分析法分析99例確診為新生兒細菌性腦膜炎患兒的臨床病歷資料，對其臨床錶現、實驗室檢查結果、頭顱影像學檢查情況及臨床轉歸進行分析。結果99例患兒中，＜7 d 髮病佔29．29％，農村患兒佔62．63％，早產兒佔17．17％；臨床錶現為反應差的患兒佔82．83％，體溫大于38．5℃佔67．68％，肌張力改變佔44．44％，驚厥佔29．29％，原始反射減弱佔40．40％。初次外週血感染指標檢查結果和腦脊液（CSF）檢查暘性率均不高，其中外週血 C-反應蛋白（CRP）異常率稍高于外週血白細胞計數異常率，但差異無統計學意義（45．46％比38．38％，P ＞0．05）；外週血降鈣素原（PCT）與 CRP 異常率有明顯差異（70．00％比50．50％，P ＜0．05）。從血液和 CSF 培養齣的各種緻病菌中， G－菌稍多于 G＋菌，血培養暘性率為26．26％，G－菌佔53．85％，其中10例（38．46％）為多重耐藥菌。腦脊液培養暘性率為11．11％，G－菌佔54．55％，其中5例（45．45％）為多重耐藥菌。80例患兒行頭顱 CT 或 MRI 檢查，異常頭顱 CT 及 MRI 患兒佔28．75％（23／80）。結論新生兒細菌性腦膜炎的臨床錶現無特異性，早期診斷較睏難。對該病的早期診斷依賴于臨床 PCT、CRP、血培養以及腦脊液等多項檢驗的聯閤判定。
목적：연구신생인세균성뇌막염적발병인군、림상표현、실험실검사급전귀적특점。방법채용회고성분석법분석99례학진위신생인세균성뇌막염환인적림상병력자료，대기림상표현、실험실검사결과、두로영상학검사정황급림상전귀진행분석。결과99례환인중，＜7 d 발병점29．29％，농촌환인점62．63％，조산인점17．17％；림상표현위반응차적환인점82．83％，체온대우38．5℃점67．68％，기장력개변점44．44％，량궐점29．29％，원시반사감약점40．40％。초차외주혈감염지표검사결과화뇌척액（CSF）검사양성솔균불고，기중외주혈 C-반응단백（CRP）이상솔초고우외주혈백세포계수이상솔，단차이무통계학의의（45．46％비38．38％，P ＞0．05）；외주혈강개소원（PCT）여 CRP 이상솔유명현차이（70．00％비50．50％，P ＜0．05）。종혈액화 CSF 배양출적각충치병균중， G－균초다우 G＋균，혈배양양성솔위26．26％，G－균점53．85％，기중10례（38．46％）위다중내약균。뇌척액배양양성솔위11．11％，G－균점54．55％，기중5례（45．45％）위다중내약균。80례환인행두로 CT 혹 MRI 검사，이상두로 CT 급 MRI 환인점28．75％（23／80）。결론신생인세균성뇌막염적림상표현무특이성，조기진단교곤난。대해병적조기진단의뢰우림상 PCT、CRP、혈배양이급뇌척액등다항검험적연합판정。
ABSTRACT:Objective To study the onset population,clinical manifestations,laboratory tests and outcomes of neonatal bacterial meningitis.Methods Clinical data of 99 newborns with bacte-rial meningitis were analyzed retrospectively.Clinical manifestations,laboratory examinations, cranial imaging findings and clinical outcomes were analyzed.Results Among the 99 newborns, 29.29% had bacterial meningitis within 7 days after birth,62.63% came from countryside, 17.17% were premature,82.83% showed poor clinical manifestations,67.68% had fever(body temperature>38.5 ℃),44.44% had muscle tone change,29.29% had convulsion,and 40.40%had weak primary reflex.The positive rates of the first results from peripheral blood and cerebro-spinal fluid(CSF)detection were not high.The abnormality rate of C-reactive protein(CRP)de-tection was slightly higher than that of peripheral white blood cell count(45.46% vs 38.38%, P >0.05),but significantly lower than that of procalcitonin(50.50% vs 70.00%,P <0.05).A-mong the pathogenic bacteria isolated from peripheral blood and CSF,the number of gram-nega-tive(G- )bacteria was higher than that of gram-positive(G+ )bacteria.Among newborns with positive blood culture results(26.26%),53.85% were infected with G- bacteria,including 10 ca-ses with multidrug-resistant bacterial infections(38.46%).Among newborns with positive CSF culture results(11.11%),54.55% were infected with G- bacteria,including 5 cases with multi-drug-resistant bacterial infections(45.45%).Among the 80 newborns who underwent cranial CT or MRI,the results were abnormal in 23(28.75%).Conclusion Neonatal bacterial meningitis has no special clinic manifestations,and is difficult to diagnose early.The early diagnosis of neonatal bacterial meningitis depends on the combination of PCT detection,CRP determination,blood cul-ture and CSF test.The prenatal/neonatal health propagation and education should be strength-ened to decrease the incidence of neonatal bacterial meningitis in newborns from countryside.
