小儿难治性化脓性脑膜炎的临床特点及致病因素

Clinical characteristics and pathogenic factors of refractory purulent meningitis in children

目的探讨小儿难治性化脓性脑膜炎(化脑)的临床特点和致病因素。方法回顾性分析15例难治性化脑患儿的临床资料。结果本组患儿的临床表现为急起高热、头痛或精神差、前囟隆起;常规抗生素治疗效果差,或停药后很快复发。实验室和影像学检查发现,合并CSF鼻漏1例、硬膜下积液3例、脑积水2例,以及药物相关性炎症6例、特殊细菌感染2例、脊柱结构异常(窦道)1例。经调整抗生素及其剂量、疗程,加用糖皮质激素,针对病因(包括外科手术)治疗;或停用抗生素;本组患儿痊愈13例,遗留脑室扩大1例,无效1例。结论小儿难治性化脑常规治疗效果差、易复发、原因复杂多样,特殊致病菌、并发症、局部结构及免疫功能异常、抗生素选择不当是其主要的致病因素。经合理调整抗生素或加用糖皮质激素、去除致病原因,大部分患儿的预后较好。

Objective To explore the clinical characteristics and pathogenic factors of refractory purulent meningitis in children . Methods The clinical data of 15 children with refractory purulent meningitis were retrospectively analyzed .Results The clinical manifestations in those children were with quickly morbidity high fever, headache or mental difference , anterior fontanelle bulge .And conventional antibiotic treatment effect was poor, or relapsed soon after stopping .Laboratory and imaging examination found that combined CSF rhinorrhea in 1 case, subdural effusion in 3 cases, hydrocephalus in 2 cases, as well as 6 cases of drug-related inflammation, 2 cases of special bacterial infection, one case of spinal structural abnormalities （sinus）.After adjusting antibiotics（dose, duration）, plus glucocorticoids, or treatment for the cause（including surgery）, discontinuation of antibiotics, 13 cases were cured . One case was leaved with left ventricular dilatation and 1 case without any improvement . Conclusions Conventional treatment effect of refractory purulent meningitis in children is poor and easy to relapse because of complex and varied reasons .The main factors include special pathogens , complications , local structural abnormality and immune dysfunction , improper choice of antibiotics . Reasonably using the antibiotics or plus corticosteroids or removing etiopathogenesis , most children can have a good prognosis .