新生儿化脓性脑膜炎脑脊液酸碱平衡与电解质变化的研究

Clinical study on acid-base and electrolytes values of cerebrospinal fluid in neonatal purulent meningitis

目的分析化脓性脑膜炎新生儿脑脊液电解质、酸碱平衡的临床意义。方法收集521医院新生儿科2013年1月—2017年6月,确诊为化脓性脑膜炎的患儿44例作为观察组,以同时期收治的未患颅内感染性疾病的患儿40例为对照组,对所有患儿进行脑脊液电解质、气体分析测定。观察组临床治愈后再复测。结果 1)观察组治疗前脑脊液PCO_2、HCO_3^-、BE、乳酸(Lac)、Cl^-与对照组相比差异有统计学意义(P<0.05),而K^+、Na^+、Ca^(2+)差异无统计学意义(P>0.05);2)观察组治疗前与临床治愈后脑脊液pH、PCO_2、HCO_3^-、BE、Lac、Cl^-差异有统计学意义(P<0.05),而K+、Na^+、Ca^(2+)差异无统计学意义(P>0.05);3)观察组脑脊液的pH、PCO_2、Lac同动脉血上述酸碱变量之间存在相关性。结论化脓性脑膜炎患儿存在脑脊液酸碱失衡及Cl^-的减低,脑脊液气体分析、Cl^-测定可作为诊断、评价治疗效果的直接客观指标。

Objective To analyze the acid-base and electrolytes values of cerebrospinal fluid（CSF） in neonatal purulent meningitis. Methods Totally forty-four neonates with purulent meningitis in department of neonatology from January 2013 to June 2017 were selected as observation group, and forty neonates without purulent meningitis in the same term were selected as control group. The acid-base and electrolytes values of CSF were analyzed. CSF of observation group were retested after treatment. Results 1）Before treatment, there was obvious difference between the two groups on the values of PCO2、HCO-3、BE、Lac、Cl- in CSF（P〈0.05）, but there was no significant difference between the two groups on the values of K＋、Na＋、Ca2＋ in CSF（P〉0.05）. 2）Compared with observation group before treatment, there was obvious difference on the values of pH、PCO2、HCO-3、BE、Lac、Cl- in the CSF of observation group after treatment（P〈0.05）, but there was no difference on the values of K＋、Na＋、Ca2＋ in the CSF（P〉0.05）. 3）The values of pH、PCO2and Lac in CSF in the observation group were correlated with those in arterial blood. Conclusion CSF in neonatal purulent meningitis has acid-base imbalance and Cl-reduction, so acid-base and electrolytes values of CSF can help early diagnosis and the evaluation of treatment efficacy of purulent meningitis.