地塞米松辅助头孢曲松钠治疗小儿化脓性脑膜炎的效果观察

Effect of dexamethasone combined with ceftriaxone sodium on children with purulent meningitis

目的探讨地塞米松辅助头孢曲松钠治疗小儿化脓性脑膜炎(PM)的临床疗效。方法回顾性分析2020年1月至2021年12月郑州大学附属儿童医院收治的106例PM患儿的临床资料。根据治疗药物分为单药治疗组(53例)和联合药物治疗组(53例)。单药治疗组在对症支持治疗的基础上给予头孢曲松钠治疗,联合药物治疗组在对症支持治疗的基础上给予地塞米松与头孢曲松钠联合治疗。比较两组患儿的临床疗效,临床症状改善情况,治疗前后炎性因子、脑脊液生化、神经功能指标及治疗期间并发症的发生情况。结果联合药物治疗组的临床总有效率(94.34%,50/53)高于单药治疗组(79.25%,42/53),P<0.05。联合药物治疗组患儿的退烧时间、颅内压恢复正常时间、外周血和脑脊液白细胞恢复正常时间、住院天数均少于单药治疗组(P均<0.05);治疗14 d后,联合药物治疗组血清C反应蛋白、降钙素原、肿瘤坏死因子-α水平,脑脊液蛋白浓度、白细胞数量,以及血浆溶血磷脂酸、同型半胱氨酸水平均低于单药治疗组(P均<0.05),脑脊液糖浓度、血浆脑源性神经营养因子水平高于单药治疗组(P<0.05)。治疗期间,联合药物治疗组并发症发生率(16.98%,9/53)与单药治疗组(13.21%,7/53)比较差异未见统计学意义(P>0.05)。结论与单用头孢曲松钠相比,采用地塞米松与头孢曲松钠联合治疗小儿PM具有较好的临床疗效,还可显著降低患儿的炎性因子水平,有效改善患儿脑脊液生化指标和神经功能,有助于PM患儿早日康复。

Objective To investigate the clinical efficacy of dexamethasone combined with ceftriaxone sodium on children with purulent meningitis(PM).Methods The clinical data of 106 children with PM admitted to Children’s Hospital Affiliated to Zhengzhou University from January 2020 to December 2021 were retrospectively analyzed.According to therapeutic drugs,they were divided into single drug group(53 cases)and combined drug group(53 cases).Children in the single drug group were treated with ceftriaxone sodium based on the symptomatic support treatment,and children in the combined drug group were treated with dexamethasone combined with ceftriaxone sodium based on the symptomatic support treatment.The clinical efficacy,improvement of clinical symptoms,preoperative and postoperative inflammatory factors,cerebrospinal fluid biochemistry,neurological indicators,and complications during treatment were compared between the two groups.Results The total clinical effective rate of the combined drug group(94.34%,50/53)was higher than that of the single drug group(79.25%,42/53),P<0.05.The time of fever abatement,time of intracranial pressure return to normal,time of peripheral blood and cerebrospinal fluid leukocyte return to normal and hospital stay in the combined drug group were lower than those in the single drug group(all P<0.05).After 14 days of treatment,the levels of serum C-reactive protein,procalcitonin,tumor necrosis factor-α,cerebrospinal fluid protein concentration,white blood cells,plasma lysophosphatidic acid and homocysteine in the combined drug treatment group were lower than those in the single drug treatment group(all P<0.05),while the cerebrospinal fluid glucose concentration and plasma brain derived neurotrophic factor levels were higher than those in the single drug group(P<0.05).During the treatment period,there was no statistically significant difference in the incidence of complications between the combined drug treatment group(16.98%,9/53)and the single drug treatment group(13.21%,7/53),P>0.05.Conclusions Compared with single ceftriaxone sodium,the combination of dexamethasone and ceftriaxone sodium in the treatment of PM has better clinical efficacy.It can significantly reduce the levels of inflammatory factors in children,improve the biochemical indicators of cerebrospinal fluid and neurological function,and help children with PM recover as soon as possible.