儿童脑脓肿36例临床特征回顾性分析

Retrospective analysis of clinical features of 36 children with brain abscess

目的分析儿童脑脓肿的病因、临床特点、影像学特点、治疗及预后,进一步认识脑脓肿。方法选择2014年1月至2021年12月首都医科大学附属北京天坛医院儿科及神经外科就诊的明确诊断为儿童脑脓肿的36例住院患儿。观察儿童脑脓肿各年龄段分布情况、临床表现、病原学检查情况、影像学检查情况、外周血/脓液培养情况、寄生虫感染情况、病因分析、治疗情况及预后情况。结果儿童脑脓肿发病年龄中<11岁24例。儿童脑脓肿最常见的神经系统表现为头痛,其次为发热、呕吐。最常见的受累部位为额颞叶,以脓肿单发为主。外周血培养检查中,仅1例检测阳性;28例脓液培养中,12例检测阳性,以链球菌及葡萄球菌为主。36例患儿均未发现寄生虫感染。36例患儿中23例病因明确,中耳炎为最主要病因,其次为脑外伤及先天性心脏病。28例行外科手术治疗,8例内科保守治疗。36例患儿中治愈出院31例,2例遗留后遗症,3例放弃治疗。截至2021年12月未见脓肿复发,3例患儿死亡。结论婴幼儿期是儿童脑脓肿发病高峰,头痛为最常见的临床表现。中耳炎、心脏病和脑外伤是脑脓肿主要病因,以额颞叶脓肿多见,脓液培养阳性率高于血培养,链球菌居多。

Objective To analyze the etiology,clinical features,imaging features,and treatment and prognosis of brain abscess in children,and to further understand brain abscess.Methods A total of 36 hospitalized children with definite diagnosis of pediatric brain abscess admitted to the Department of Pediatrics and Neurosurgery of Beijing Tiantan Hospital,Capital Medical University from January 2014 to December 2021 were selected.The distribution at different ages,clinical manifestations,etiological examination,imaging examination,peripheral blood/pus culture,parasitic infection,etiological analysis,and treatment and prognosis of brain abscess in children were observed.Results The age<11 years of onset of pediatric brain abscess was 24 cases.The most common neurological manifestations of pediatric brain abscess were headache,followed by fever and vomiting.The most commonly affected site was the frontotemporal lobe,which was dominated by single abscess.In peripheral blood culture examination,only one case was positive;among the 28 cases of pus culture,12 cases were positive,mainly streptococcus and staphylococcus.No parasitic infection was found in the 36 children.The etiology was clear in 23 of the 36 cases,otitis media was the main cause,followed by brain trauma and congenital heart disease.A total of 28 cases underwent surgical treatment and eight cases received conservative medical treatment.Thirty-one of the 36 cases were cured and discharged from hospital,two cases had sequelae,and three cases gave up treatment.By December 2021,no abscess recurrence was observed and three patients died.Conclusion Early childhood is the peak of pediatric brain abscess,headache is the most common clinical manifestations.Otitis media,heart disease,and brain trauma are the main causes of brain abscess,frontotemporal lobe abscess is more common,the positive rate of pus culture is higher than that of blood culture,streptococcus mostly.