新生儿不同病原菌化脓性脑膜炎患者的临床预后对比分析

COMPARATIVE ANALYSIS ON THE PROGNOSIS OF NEWBORN WITH NEONATAL PURULENT MENINGITIS OF DIFFERENT PATHOGENS

目的:对比分析新生儿不同病原菌化脓性脑膜炎患者的临床预后。方法:选择2012年4月至2015年4月海南省农垦总医院收治的169例新生儿化脓性脑膜炎患儿,按照脑脊液的培养结果将患儿分为病原菌不明组、其他细菌组以及大肠埃希菌组。收集患儿住院期间以及出院后3个月的临床资料和随访资料,比较分析3组化脓性脑膜炎新生儿的一般资料。同时,观察新生儿脑脊液检查情况,测定白细胞、蛋白及含糖水平,统计患儿的脑脊液恢复正常时间、发热持续时间、住院时间和住院费用、并发症和病死情况。结果:3组化脓性脑膜炎新生儿的年龄、出生胎龄、出生体重、发病日龄比较差异无统计学意义(均P>0.05)。大肠埃希菌组化脓性脑膜炎新生儿,其脑脊液的混浊率(66.67%)和脓性率(25.00%)显著高于其他细菌组和病原菌不明组,且差异具有统计学意义(均P<0.05);3组化脓性脑膜炎新生儿的白细胞、蛋白及含糖水平比较,差异具有统计学意义(P<0.05)。大肠埃希菌组患儿的脑脊液恢复正常时间、发热持续时间、住院时间和住院费用均明显高于其他两组(均P<0.05)。大肠埃希菌组并发症的发生率为70.83%,病死率为12.50%,明显高于其他两组,差异具有统计学意义(均P<0.05)。结论:新生儿伴有大肠埃希菌感染具有相对较差的预后,因此使用抗生素需考虑是否对大肠埃希菌具有较强的敏感性,并且严密监测其并发症,提高化脓性脑膜炎患儿的预后。

Objective：To analyze the clinical prognosis of neonatal purulent meningitis casued by different pathogens.Methods：169cases of newborn children with purulent meningitis from April 2012 to April 2015 in our hospital were recruited in this study.According to the cerebrospinal fluid（CSF）culture results,all cases were divided into groups of unknown pathogens,Escherichia coli and other bacterial.Clinical data and follow-up data were collected during hospitalization and three months after discharged from hospital.Comparative analysis had been done for general information,white blood cells,protein and sugar levels in CSF,fever duration,duration of hospitalization,and mortality of all newborn.Results：The CSF turbid rate（66.67%）and purulent rate（25.00%）,and the incidence of complications（70.83%）,the mortality（12.50%）,and the recovery time of CSF,fever duration,hospitalization duration and costs in the E.coli group were significantly higher than those of other two groups（P〈0.05）.The levels of white blood cells,protein and sugar were significantly different among three groups（P〈0.05）.Conclusion：Neonatal infection with E.coli has a relatively poor prognosis;therefore the usage of antibiotics and controlling of the complications are necessary to improve the prognosis of purulent meningitis.