不典型新生儿化脓性脑膜炎早期诊断及治疗方法的临床探究

Clinical study on the early diagnosis and treatment methods for atypical neonatal purulent meningitis

目的探讨不典型新生儿化脓性脑膜炎早期诊断及治疗的临床方法,并总结临床经验。方法2011年1月至2016年6月玉林市第二人民医院新生儿科收治的不典型、迟发型新生儿化脓性脑膜炎患儿60例,收集患儿的一般人口学资料、临床表现及实验室检查资料。诊断明确者给予注射用头孢曲松钠(商品名:罗氏芬)静脉注射,50mg/(kg·次),每日2次,疗程3~4周。结果患儿入院时发热60例,嗜睡、激惹39例,皮肤花斑41例,前囟饱满27例,前囟紧张27例,肌张力高32例,肌张力低19例,无惊厥、尖叫、拒奶、凝视、呼吸衰竭等症状;治疗后全部患儿发热、激惹、皮肤花斑等症状消失,前囟变平软,肌张力恢复正常,表现为症状缓解的状态。患儿经过罗氏芬治疗后,血中白细胞计数、中性粒细胞、单核细胞和C反应蛋白浓度,脑脊液白细胞计数和蛋白含量均低于治疗前,差异有统计学意义(P<0.05)。潘氏试验阳性率、血培养阳性率和脑脊液培养阳性率均低于治疗前,差异有统计学意义(P<0.05)。头颅MRI显示异常者11例,其中蛛网膜下腔增宽11例,脑积水8例,硬膜下积液1例,脑积水伴脑室管膜炎1例。后遗症发生率为18.3%(11/60)。结论发热、嗜睡、激惹是不典型新生儿化脓性脑膜炎的重要早期表现;皮肤花斑、前囟饱满、紧张、肌张力改变为其重要体征,入院及时予脑脊液检查,可以及时诊断化脓性脑膜炎,给予罗氏芬治疗可以及早控制病情,预防惊厥等严重脑水肿的发生,降低后遗症和死亡病例的发生率。

Objective To investigate the clinical methods for early diagnosis and treatment of atypical neonatal purulent meningitis and summarize the clinical experience. Methods A total of 60 cases of children with atypical neonatal purulent meningitis were included, who were hospitalized in our Neonatal Department from January 2011 to June 2016. Collect the children＇s information, including general demographic informa- tion, clinical manifestation and the laboratory examination data. Intravenous injection of ceftriaxone sodium （brand name.. Rocephin） was given, 50 mg/kg/time, twice a day, to the clearly diagnosed cases, which las- ted 3 to 4 weeks. Results The children＇s clinical manifestations when hospitalized were as follows., fever in 60 cases; somnolence and irritation in 39 cases; piebaldskin in 41 cases; full bregma in 27 cases; bregma nervous in 27 cases; high muscular tension in 32 cases; low muscular tension in 19 cases; no symptom of convulsions, screaming, milk rejecting, staring or respiratory failure. After treatment, the symptoms of fe- ver, irritation and piebaldskin in all the patients disappeared. Bregma became flat and soft, muscular tension returned normal, and the symptom was relived. After Rocephin treatment, white blood cell count, neutro- phil, M%＆ content of C-reactive protein, CSF white blood cell count, and protein content were lower than those before treatment, and the difference was statistically significant （P〈0.05）. Positive rate of Pandys test, blood culture and CSF culture was lower than the rate before treatment and there is statistically signifi- cant difference（P〈0.05）. Brain MRI indicated abnormal in 11 cases, including enlargement of subarachnoid spaces in 11 cases, hydrocephalus in 8 cases, subdural effusion in 1 case, and hydrocephalus with Ependym- itis in 1 case. The rate of sequelae was 18.3% （11/60）. Conclusion Fever, somnolence and irritation are the important manifestations of atypical neonatal purulent meningitis in early stage. Piehaldskin, full bregma and nervous, and dystonia are the vital signs. Providing timely CSF examination at hospitalization can help the early diagnosis of purulent meningitis, and the disease can be controlled as soon as possible with Rocephin treat- ment, which also prevents convulsion and other cerebral edema, reducing the incidence of sequelae and death.