新生儿B群溶血性链球菌性脑膜炎10例临床分析

10 cases of clinical analysis on group B hemolytic streptococcus meningitis of neonates

目的探讨B群溶血性链球菌(GBS)性脑膜炎临床特点和治疗方案。方法对2008~2015年我院收治10例GBS败血症合并脑膜炎患儿临床资料行回顾性分析。结果 10例GBS败血症合并脑膜炎患儿中,4例为早发型,其中1例于出生后3d发病,以高热、抽搐入院,3例以气促为最初表现;6例为晚发型,均以中高热为最初表现。6例患儿WBC<4×10~9/L,3例患儿WBC为(10~20)×10~9/L,1例患儿WBC>20×10~9/L。行脑脊液检查,10例GBS均阳性,脑脊液呈典型化脓性脑膜炎改变。行血培养,均显示GBS阳性。入院经X线检查显示,10例均存在肺部感染;出院时7例经MRI检查,1例存在脑膜增厚;3例经头颅CT检查1例存在外部性脑积水。所有患儿均采用青霉素/万古霉素+美罗培南联合治疗,均治愈出院。随访1年,9例后期生长发育正常,1例发育略显缓慢。结论新生儿GBS脑膜炎临床特点各异,病情严重,针对可疑新生儿,应尽早行血培养以明确致病菌,及时进行脑脊液检查以确诊,早期、足疗程使用敏感抗生素治疗为减少并发症及后遗症之关键。

Objective To explore the clinical features and therapeutic scheme of group B hemolytic streptococcus（GBS） meningitis. Methods The clinical data of 10 children with GBS septicemia complicated with meningitis who were admitted to our hospital from 2008 to 2015 were retrospectively analyzed. Results Among children with GBS septicemia complicated with meningitis s, 4 cases were early-onset type. Of whom, 1 case had diseases on the 3rd day after birth and was admitted for high fever and convulsions. The initial manifestation of 3 cases was short breath. 6 cases were late-onset type and they were all with initial manifestation of high fever. 6 cases were late onset type, of whom the initial manifestation was middle and high fever. There were 6 cases with WBC 〈 4 × 109/L, 3 cases with WBC （10 - 20） ×109/L and 1 case with WBC 〉 20 ×109/L. After cerebrospinal fluid examination, GBS of 10 cases was positive and cerebrospinal fluid showed typical purulent meningitis. Blood culture showed positive GBS. X-ray examination on admission showed that 10 cases had pulmonary infection. 7 cases underwent MRI examination and 1 cases showed thickening of meninges. 3 cases underwent brain CT and 1 case had external hydrocephalus. All patients were given penicillin/vancomycin combined with meropenem for treatment and all were cured and discharged. In the one-year follow-up, 9 cases were with normal growth and development and 1 cases was with a little slow growth and development. Conclusion Clinical features of GBS meningitis of neonates were various and the disease is severe. For neonates with suspected GBS meningitis, blood culture should be done as early as possible to figure out pathogenic bacteria and cerebrospinal fluid examination should be timely performed to confirm the diagnosis. Early and adequate use of sensitive antibiotics is the key to reducing complications and sequelae.