肺炎链球菌脑膜炎15例临床特征及预后分析

Clinical characteristics and prognostic analysis of 15 children with streptococcus pneumoniae meningitis

目的 探讨儿章肺炎链球菌脑膜炎的临床特征、并发症、耐药性资料及预后,以提高对该病的诊疗水平.方法 回顾性分析2010年1月至2013年1月在山东大学齐鲁儿童医院确诊为肺炎链球菌脑膜炎的15例住院患儿的临床资料及细菌培养等检测结果,并对患儿随访0.5年以了解预后.结果 15例患儿中11例发生于冬、春季,以2岁以下婴幼儿多见（占13例）,忠儿均来自农村;临床表现多样,症状严重,体征及腑脊液改变明显,并发症和后遗症多,部分重症或死亡患儿体温不升,且有白细胞或血小板降低;贫血（10例）、低蛋白血症（9例）、脓毒症（8例）为肺炎链球菌脑膜炎忠儿常见的并发症;多重耐药及并发症出现是治疗困难的主要原因;15例患儿中痊愈3例,9例患儿遗留语言、运动、脑积水、认知功能障碍,死亡3例,多脏器功能障碍综合征是肺炎链球菌脑膜炎患儿死亡的主要原因.结论 肺炎链球菌脑膜炎好发于2岁以下居住于农村的婴幼儿,临床表现及脑脊液改变明显;重症患儿可表现为体温不升,且白细胞或血小板降低,并发症和后遗症多;多重耐药及并发症山现是治疗困难的主要原因.

Objective To summmrize the clinical characteristics complications,antimicrobial resistance and prognosis in 15 children with streptococcus pneumoniae meningitis so as to improve the diagnosis and treatment of this disease.Methods A systematic retrospective analysis was carried out in the Qilu Children＇s Hospital of Shandong University from Jan.2010 to Jan.2013,and clinical data from 15 children with streptococcus pneumococcal meningitis were retrospectively analyzed and followed up for 6 months in order to observe the prognosis.Results Eleven cases of streptococcus pneumoniae meningitis occuned in the winter and spring.And it often occuned in children less than 2 years of age who lived in rural areas （13 cases）.The clinical manifestations showed diverse characteristics,severe symptoms,obvious changes in symptoms and cerebrospinal fluid were observed.Severe or death cases had low temperature,low leukopenia or low blood platelet.Common complications of streptococcus pneumoniae meningitis included anemia （10 cases）,hypoalbuminemia （9 cases）,sepsis （8 cases）.Multi-drug resistance and complications in streptococcus pneumoniae meningitis led to the therapeutic difficulties.In this study,3 cases were cured,9 cases had varying degrees of sequences,such as left languages,sports,hydrocephalus and cognitive dysfunction,and 3 cases died,and the main cause of death was multiple organ dysfunction syndrome.Conclusions Streptococcus pneumoniae meningitis mainly occurred in the winter and spring.And the children under 2 years of age who lives in rural areas were often attacked.Clinical characteristics and cerebrospinal fluid changes obviously; severe cases are common with low temperature,low leukopenia or blood platelet.And there aye often diverse complications and multi-sequelae; the problem of multi-drug resistant and complications can lead to great difficulties in the clinical treatment.