新生儿细菌性脑膜炎45例

Forty-Five Cases of Neonatal Bacterial Meningitis

目的分析新生儿细菌性脑膜炎的临床表现、病原学特征及治疗方法 ,为早期诊断及治疗提供临床依据。方法对本院新生儿科2005年12月-2010年7月收治的45例新生儿细菌性脑膜炎的临床资料进行回顾性分析。根据发病日龄分为≤7 d组(15例)和>7 d组(30例),分析2组一般情况、临床表现、实验室检查及治疗方法等。结果临床表现以发热(86.7%)、抽搐(66.7%)、激惹(35.6%)为主,>7 d组肌张力升高、脑膜刺激征阳性多见。脑脊液培养阳性11例(24.4%)、涂片阳性3例(6.7%)、血培养阳性18例(40.0%),其中,凝固酶阴性葡萄球菌12例,G-杆菌11例。脑脊液蛋白水平与白细胞计数在脑脊液培养阳性、涂片阳性或查见脓细胞(18例)患儿与未见明确病原学特征(27例)患儿比较,差异无统计学意义。选用β-内酰胺类联合第三或第四代头孢菌素治疗,培养有阳性细菌生长后,再根据药敏试验及临床疗效选用敏感抗生素。治愈33例(73.3%),无效1例(2.2%),放弃治疗11例(24.5%),包括症状缓解5例和未愈6例。结论新生儿细菌性脑膜炎临床表现不典型,神经系统体征在发病日龄>7 d时表现相对明显;凝固酶阴性葡萄球菌为最常见的致病菌;治疗以β-内酰胺类联合第三代或第四代头孢菌素为主。

Objective To provide the clinical evidence by analyzing clinical manifestations,bacteriologic features and treatment for early diagnosis and therapy of neonatal bacterial meningitis.Methods From Dec.2005 to Jul.2010,45 newborn infants with bacterial meningitis were admitted,and they were classified into ≤7 d group and 7 d group according to the time when their symptoms began to develop.Their conditions,clinical manifestations and laboratory tests results were retrospectively reviewed.Results Three most common manifestations were fever（86.7%）,seizures（66.7%） and irritation（35.6%）.Hypermyotonia and positive meningeal irritation were more common in 7 d group.There were 11 cases（24.4%） with positive cerebrospinal fluid（CSF）culture,3 cases（6.7%） with positive CSF-smear and 18 cases（40.0%） with positive blood culture.Furthermore,coagulase negative staphylococci and G-bacillus were 2 mostly identified pathogens,and there were 12 cases,11 cases respectively.The concentration of protein and WBC in CSF showed no significant difference between the 2 groups of positive or negative CSF cultures（P0.05）.Both of β-lactam antibiotics and third or fourth generation cephalosporins were empirically used before the results of drug sensitive test.Thirty-three cases（73.3%） cured,1 case（2.2%） failed,11 cases（24.5%） withdrew,which inclu-ded 5 cases who relieved therapy,and 6 cases were uncured.Conclusions The clinical manifestations of neonatal bacterial meningitis are atypical,and the signs of central nervous system are more easily induced in 7 d group.The most common causative pathogen is coagulase negative staphylococci.β-lactam antibiotics combined with third or fourth generation cephalosporins should be used empirically.