新生儿化脓性脑膜炎脑脊液变化特点分析

Characteristics of cerebrospinal fluid in neonatal purulent meningitis

目的分析化脓性脑膜炎患儿病程中脑脊液白细胞分类、糖和蛋白变化特点以及病原菌情况。方法采用回顾性分析研究的方法，选择2011年6月至2013年6月在我院新生儿科住院治疗的31例典型化脓性脑膜炎患儿，对其临床特点、病原学、脑脊液实验室检查进行分析。结果31例患儿中，发热28例（90．3％），惊厥21例（67．7％），意识改变18例（58．1％），胃肠功能紊乱8例（25．8％），呼吸改变5例（16．1％），颈抵抗5例（16．1％），前囟饱满3例（9．7％）。在脑脊液及血液中培养出的病原菌以革兰阴性杆菌多见，其中以大肠埃希菌最多，血培养38．1％（8／21）、脑脊液培养55．5％（5／9）。脑脊液细菌培养阳性率低于血培养（29．0％VS,．67．7％）。所纳入研究对象其脑脊液细胞分类在发病1周内均以多核为主[（79．61±12．06）％]，7例在1—2周以多核为主，只有2例在2～3周时仍以多核为主，3周后无以多核细胞为主者。结论典型新生儿化脓性脑膜炎脑脊液白细胞分类1周内以多核细胞为主，之后单核细胞比例逐渐增加并占优势。大肠埃希菌是引起本病较常见的病原菌。

Objective To analyze the changes of WBC classification, sugar and protein in cerebrospinal fluid （CSF） and pathogenic bacteria of neonatal purulent meningitis. Methods Thirty-one neonates with bacterial meningitis in our department of neonatology from June 2011 to June 2013 were enrolled, and the clinical features, pathogenic bacteria, laboratory examination of CSF were analyzed. Results Fever （90. 3% ） ,convulsions（67.7% ） and changed consciousness（58. 1% ） were common clinical symptoms. The incidences of other nervous system abnormal signs such as gastrointestinal dysfunction （25.8%）, abnormal breathing（ 16. 1% ） ,cervical resistance（ 16. 1% ） ,bulging fontanel（9.7% ） were lower. The Gram - negative bacteria was more than Grampositive in both blood and CSF culture. The escherichia coli was the most common bacteria, with positive rate of 38. 1% （8/21）in blood culture and 55.5% （5/9）in CSF culture. The germiculture positive rate in CSF was lower than in blood culture （29. 0% vs. 67.7% ）. Polymorphonuclear leukocyte（PMN） [ （79. 61 ± 12. 06） % ] was the most predominant cell of the leukocyte classification in CSF within 1 week in all cases, PMN was still predominant in 1 to 2 weeks in 7 cases, while only 2 cases in 2 to 3 weeks still dominated by PMN,PMN was not the predominant cell 3 weeks later. Conclusion In the typical neonatal purulent meningitis, PMN was the predominant cell in CSF within the first week, but the proportion of monocyte gradually increased and was dominant later. Escherichia coli was a common bacteria caused by this disease.