新生儿化脓性脑膜炎的临床特点与早期诊断

Clinical Features and Early Diagnosis of Neonatal Purulent Meningitis

目的探讨新生儿化脓性脑膜炎的临床特点与早期诊断方法。方法选择2010年3月-2011年12月就诊于本院新生儿科疑似化脓性脑膜炎患儿100例,均于本院应用抗生素前行腰椎穿刺术,留取脑脊液(CSF)标本行常规、生化检测及培养,同时留取CSF 1 mL行PCR检测16 S rRNA。结果临床诊断为化脓性脑膜炎者40例,其中发热36例(90%),惊厥29例(72.5%),呼吸暂停5例(12.5%),前囟饱满23例(57.5%)。临床诊断为化脓性脑膜炎40例患儿,其CSF PCR检测均为阳性。CSF培养阳性5例,该5例CSF参数异常,PCR检测均呈阳性。PCR检测16 S rRNA阳性58例,PCR阳性率明显高于CSF培养、CSF参数(χ2=65.09,P=0.00;χ2=6.48,P=0.01)。结论新生儿化脓性脑膜炎临床特点不典型,CSF检查存在一定局限性,CSF培养阳性率低,结合PCR检测能提高阳性率。

Objective To explore the clinical features and the early diagnosis of the neonatal purulent meningitis. Methods One hun- dred cases with suspected neonatal purulent meningitis in Department of Pediatrics, Xi＇an Children＇s Hospital ,from Mar. 2010 to Dec. 2011, were chosen to take lumbar puncture for getting the samples for routine test（ including count white blood cell and biochemical test）, and cul- ture before antibioties administration,and meanwhile the PCR was used to detect the 16 S rRNA with 1 mL out of ew^ry sample. Results Ac- cording to the clinical and cerebrospinal fluid parameters 40 cases were diagnosed clinically with purulent meningit!s. Among them,36 cases with fever （90%） ,29 cases with convulsion （72.5%） ,5 cases with apnea（ 12.5% ） ,and 23 cases with bulging fontanel （57.5%）. The 40 cases of clinically diagnosed as purulent meningitis, PCR detection were all positive. Cerebrospinal fluid culture was positive in 5 cases ,whose cerebrospinal fluid parameters were abnormal and PCR were positive. Fifty - eight cases had positive 16 S rRNA（ riosomal RNA） detection. The positive rate of PCR detection was remarkably higher than the ones of the 2 formers（x2 = 65.09 ,P = 0.00 ;X2 = 6.48 ,P = 0. 01 ）. Conclusions The diagnosis of neonatal purulent meningitis is difficult because of atypical clinical features,limited cerebrospinal fluid parameters and low positive rate of cerebrospinal fluid culture. PCR can improve the positive rate.