足月与早产化脓性脑膜炎患儿临床指标的差异性分析

Clinical analysis of the difference between full-term and preterm infants with purulent meningitis

目的对比分析早产和足月化脓性脑膜炎(NPM)患儿的临床特点及相关指标的差异性,尽早诊断,及时治疗。方法回顾性分析该院72例新生NPM患儿,根据胎龄,分为足月儿组(33例)和早产儿组(39例)。对比两组患儿的基本临床资料、临床症状和体征、合并其他系统感染情况、血液和脑脊液实验室检查结果、病原学检查结果。结果两组患儿性别、入院日龄、发病日龄等相关资料差异无统计学意义(P>0.05)。足月儿组低体质量儿的发生率为6.1%,明显低于早产儿组(59.0%),且差异具有统计学意义(P<0.05)。足月儿组NPM患儿以发热(75.8%)、惊厥(45.5%)、反应差(78.8%)、拒奶(45.5%)等为主要临床表现;而早产儿组NPM患儿以黄疸(30.8%)、呼吸暂停(20.5%)、肌张力降低(61.5%)为主要临床表现。足月儿组患儿合并败血症的概率为51.5%,高于早产儿组(20.5%),且差异具有统计学意义(P<0.05)。患儿血液和脑脊液实验室检查结果显示,18例(54.5%)足月儿组NPM患儿表现出C反应蛋白(CRP)升高,与早产儿组患儿(28.2%)相比,差异具有统计学意义(P<0.05)。早产儿组NPM患儿脑脊液蛋白水平为(2.35±0.78)g/L,明显高于足月儿组患儿(1.57±0.99)g/L;葡萄糖水平为(1.84±0.69)mmol/L,明显低于足月儿组患儿(2.21±0.81)mmol/L,差异具有统计学意义(P<0.05)。此外,2例(6.1%)足月儿组NPM患儿脑脊液细菌学检查呈阳性,15例患儿血液细菌学检查呈阳性。结论由于新生儿NPM临床症状不典型,足月儿组NPM患儿和早产儿组NPM患儿的临床指征和实验室检查也存在一定差异,医生需密切观察新生儿的临床表现,尽早诊断、及早治疗,尽量降低患儿的病死率和致残率。

Objective To discuss and compare the clinical characteristics and difference of full-term and preterm neonatal purulent meningitis（NPM）,for early diagnosis and reasonable treatment.Methods 72 newborns with NPM were collected.According to the gestational age,33 cases were divided into the full-term group（37-42weeks）and 39 cases were divided into the preterm group（37weeks）.The clinical data,symptoms and signs,the related infection,the lab tests of blood and cerebrospinal fluid and pathogenic examination were analyzed and compared.Results The sex,the day age of hospital admission and onset between the two groups were no difference（P0.05）.The rate of low-birth weight infant was 6.1%,which was significantly lower than preterm neonates（59.0%）（P0.05）.The mainly clinical manifestations of full-term newborns with NPM were fever（75.8%）,convulsions（45.5%）,poor response（78.8%）,and poor eating milk（45.5%）.But the mainly clinical manifestations of preterm neonates with NPM were jaundice（30.8%）,apnea（20.5%）and lower muscular tension（61.5%）.There were 17cases（51.5%）with NPM combined with septicemia in the full-term group,which was more than preterm neonates（20.5%）（P0.05）.According to the results of the lab tests,18full-term neonates（54.5%）with NPM with increased CRP levels were more than preterm neonates（28.2%）（P0.05）.Besides,the preterm NPM neonates showed higher protein levels（2.35±0.78）g/L and lower glucose（1.84±0.69）mmol/L in cerebrospinal fluid than these in the full-term group（P0.05）.However,there was only 2full-term NPM neonate with apositive cerebrospinal fluid culture,and 15 patients with a positive blood culture（8full-term neonates and 7preterm neonates）.Conclusion Because of the atypical clinical characteristics and difference between the full-term neonates and the preterm neonates,the clinical symptoms and signs of neonates should be closely monitored.Therefore,it′s suggested that the early diagnosis and reasonable treatment be a key plan for the low mortality and disability.