新生儿化脓性脑膜炎临床诊治经验与病原菌分析

Clinical Diagnosis and Treatment Experience of Neonatal Purulent Meningitis and Analysis of Pathogenic Bacteria

目的:分析探讨新生儿化脓性脑膜炎的病原菌和临床诊治经验。方法:选取我院2014年2月至2016年1月收治的新生儿化脓性脑膜炎患儿60例,回顾性分析所有入选患儿的临床资料,包括实验室检查结果、临床表现、临床转归情况、头颅影像学检查结果、病原菌分布等。结果:60例新生儿化脓性脑膜炎患儿外周血中C-反应蛋白的异常率高于外周血中白细胞异常率(χ2=6.384,P<0.05),脑脊液中的白细胞计数异常率高于蛋白含量异常率(χ2=11.284,P<0.01)。在对60例患儿的细菌血培养和脑脊液培养结果中,28例患儿细菌培养呈阳性,共分离病原菌33株且均为条件致病菌,其中19例(67.9%)患儿分离菌株对3种以上的抗菌药物耐药,为多重耐药菌。结论:新生儿化脓性脑膜炎病原菌的耐药率越来越高,由于早期诊断的困难,该病的治疗和预后均不理想,因此,需要早期对高危因素患儿进行密切的临床监测和反复的脑脊液检查。

Objective： To analyze the pathogenic bacteria,clinical diagnosis and treatment experience of neonatal purulent meningitis.Methods： Sixty cases with neonatal purulent meningitis treated during February 2014 to January 2016 in our hospital were selected,all clinical data were retrospectively analyzed,including laboratory test results,clinical manifestations,clinical outcomes,brain imaging examination results,pathogen distribution about the children with the clinical experience of diagnosis and treatment. Results： Sixty cases of neonatal purulent meningitis in children with abnormal rate of peripheral blood C-reactive protein was significantly higher than that in the abnormal rate of peripheral blood white blood cell（ χ2= 6. 384,P〈0. 05）. The abnormal rate of cerebrospinal fluid white blood cell count was higher than protein content（ χ2= 11. 284,P〈0. 01）. Culture results in 60 cases of children with bacterial cultures of blood and cerebrospinal fluid,a total of 28 cases of children with bacterial cultures were positive,and the 33 isolated strains were all conditional pathogenic bacteria,which 19 cases（ 67. 9%） strains were resistant to more than three kinds of antibiotics,which were multi drug resistant bacteria. Conclusion： Neonatal purulent meningitis pathogenic bacteria resistance rate is more and more higher,also due to the difficulty of early diagnosis,treatment and prognosis of the disease are not ideal. Therefore,it is necessary early on risk factors in children with close clinical monitoring and repeated examination of cerebrospinal fluid.