CAJ | 학술논문

目的：探讨影响儿童化脓性脑膜炎近期不良预后的危险因素。方法回顾性观察89例化脓性脑膜炎患儿的临床资料,根据 Glasgow 临床结局评分标准比较预后良好组与预后不良组在基本特征、临床表现、并发症、辅助检查、治疗等方面的异同；采用 t 检验和卡方检验或方差分析,筛选出有统计学意义的相关联因素,再以单因素分析筛选出的有意义的相关联的因素为自变量,Glasgow 临床结局评分为因变量,在非条件 Logistic 回归模型下进行多因素分析,探讨影响儿童化脓性脑膜炎不良预后的独立危险因素。结果单因素分析显示,发病年龄、呕吐、意识障碍/昏迷、惊厥、前囟隆起、瞳孔对光反射迟钝、肌张力异常、并发症、颅脑 CT/MRI 检查异常、C-反应蛋白、脑脊液糖浓度、脑脊液蛋白浓度、脑脊液乳酸浓度、脑脊液糖/血糖比值、低钙血症、使用丙种球蛋白共16项指标与儿童化脓性脑膜炎近期不良预后有关联；非条件 Logistic 回归分析显示,年龄小、意识障碍/昏迷、惊厥、脑脊液乳酸升高、低脑脊液糖/血糖比值与不良预后独立相关。结论年龄小、意识障碍/昏迷、惊厥、脑脊液乳酸升高、脑脊液糖/血糖比值降低是影响儿童化脓性脑膜炎近期不良预后的独立危险因素。尽早识别存在不良预后风险的患儿,并采取充分有效监护和更为积极的治疗措施,以期在一定程度上改善患儿预后。
목적：탐토영향인동화농성뇌막염근기불량예후적위험인소。방법회고성관찰89례화농성뇌막염환인적림상자료,근거 Glasgow 림상결국평분표준비교예후량호조여예후불량조재기본특정、림상표현、병발증、보조검사、치료등방면적이동；채용 t 검험화잡방검험혹방차분석,사선출유통계학의의적상관련인소,재이단인소분석사선출적유의의적상관련적인소위자변량,Glasgow 림상결국평분위인변량,재비조건 Logistic 회귀모형하진행다인소분석,탐토영향인동화농성뇌막염불량예후적독립위험인소。결과단인소분석현시,발병년령、구토、의식장애/혼미、량궐、전신륭기、동공대광반사지둔、기장력이상、병발증、로뇌 CT/MRI 검사이상、C-반응단백、뇌척액당농도、뇌척액단백농도、뇌척액유산농도、뇌척액당/혈당비치、저개혈증、사용병충구단백공16항지표여인동화농성뇌막염근기불량예후유관련；비조건 Logistic 회귀분석현시,년령소、의식장애/혼미、량궐、뇌척액유산승고、저뇌척액당/혈당비치여불량예후독립상관。결론년령소、의식장애/혼미、량궐、뇌척액유산승고、뇌척액당/혈당비치강저시영향인동화농성뇌막염근기불량예후적독립위험인소。진조식별존재불량예후풍험적환인,병채취충분유효감호화경위적겁적치료조시,이기재일정정도상개선환인예후。
Objective To investigate the risk factors for recent adverse prognosis of childhood pu-rulent meningitis. Method A total of 89 purulent meningitis patients were retrospectively analyzed. According to Glasgow prognostic score,all cases were divided into two groups,favorable and adverse out-come groups. Firstly the two different groups were compared by single factor analysis,then the signifi-cant variables were analyzed by non conditional Logistic regression. Result Single factor analysis showed that total of 1 6 indexes include age,vomit,coma/consciousness disorder,convulsion,anterior fontanelle bulge,pupillary light reflex,abnormal muscle tension,complication,brain CT/MRI abnormali-ties,CRP,cerebrospinal fluid sugar,protein and lactate,CSF/blood glucose ratio,hypocalcemia,usage of gamma globulin were associated with short-term adverse prognosis;non conditional Logistic regression analysis showed:age,coma/consciousness disorder,convulsion,high cerebrospinal fluid lactic acid,low CSF/blood glucose ratio were independently associated with poor prognosis. Conclusion Small age,co-ma/consciousness disorder,convulsions,high cerebrospinal fluid lactic acid,low CSF/blood glucose ratio were independent risk factors for recent adverse prognosis of children's purulent meningitis.