儿童化脓性脑膜炎48例临床分析

Clinical analysis of 48 cases of suppurative meningitis in children

目的分析化脓性脑膜炎(PM)患儿的临床特点及治疗转归。方法选取2009年6月至2019年12月在神木市医院儿科病房确诊的48例PM患儿的临床资料进行回顾性分析。结果 48例PM患儿发病年龄以1岁以内多见(占79.17%);男性35例(72.92%),女性13例(27.08%),男女之比为2.69∶1。临床症状以发热(40例,83.33%)、抽搐(21例,43.75%)、呕吐(20例,41.67%)为主要表现。头痛、呕吐、脑膜刺激征在高年龄段(>3~14岁)所占比例较高,不同年龄段这3种症状所占比例比较差异均有统计学意义(χ2值分别为23.676、9.428、8.834,均P<0.05)。细菌培养分离出病原菌的患儿有22例(45.83%),其中革兰阳性菌17株(77.27%),革兰阴性杆菌5株(22.73%)。临床治愈或好转33例(68.75%),未愈(伴后遗症)6例(12.50%),转院7例(14.58%),放弃1例(2.08%),死亡1例(2.08%)。并发症发生率为33.33%,依次为硬膜下积液8例、肢体活动障碍4例、听力损害2例、癫痫2例。有并发症的患儿其脑脊液白细胞(CSF-WBC)≥500×106/L、脑脊液蛋白(CSF-Pro)≥1g/L、血Na+≤130mmol/L的比例高于无并发症患儿,差异均有统计学意义(χ2值分别为5.867、5.511、8.727,均P<0.05)。结论 PM多见于1岁以内的婴儿。头痛、呕吐、脑膜刺激征在年长患儿中表现居多。当CSF-WBC≥500×106/L、CSF-Pro≥1g/L、血Na+≤130mmol/L时发生并发症或后遗症的风险高。

Objective To analyze clinical characteristics and treatment outcomes of children with suppurative meningitis(PM).Methods The clinical data of 48 PM children who were diagnozed and treated in the pediatric ward of Shenmu Municipal Hospital from June 2009 to December 2019 were retrospectively analyzed.Results The morbidity age of PM in 79.17% of 48 children was less than 1 year old,there were 35 male patients(72.92%),and 13 female patients(27.08%),and the males:females=2.69∶1.The main clinical manifestations were fever(40 cases,accountiong for 83.33%),convulsion(21 cases,43.75%) and vomiting(20 cases,41.67%).And headache,vomiting and meningeal irritation sign were more commonly seen in older children(aged >3~14 years).In proportion of the children with these three symptoms and signs,there were significant difference among the different age groups(χ~2=23.676,9.428 and 8.834 respectively,all P<0.05).The pathogenic bacteria were cultured and isolated in 22 children(45.83%),including 17(77.27%) strains of gram-positive bacteria and 5(22.73%) strains of gram-negative bacilli.33 children cured or improved(68.75%).6 children didn’t cure or had some sequelae(12.50%).7 children were tranfered to upper hospitals(14.58%).1 child abandoned the treatment(2.08%) and 1 child died(2.08%).The incidence of complications was 33.33%,including 8 cases of subdural empyema(effusion),4 cases of limb movement disorder,2 cases of hearing impairment and 2 cases of epilepsy.The proportions of CSF-WBC≥500×10~6/L,CSF-Pro≥1 g/L and blood Na^+≤130 mmol/L in the children who had some complications or sequelae were higher than those in the children who hadn’t any complications or sequelae,and the differences were statistically significant(χ~2=5.867,5.511 and 8.727 respectively,all P<0.05).Conclusion PM occurs more common in infants less than 1 year old.Headache,vomiting and meningeal irritation sign are most commonly seen in those older patients.When CSF-WBC≥500×10~6/L,CSF-Pro≥1 g/L and blood Na^+≤130 mmol/L,the risk of complications or sequelae is high.