早产儿和足月儿化脓性脑膜炎临床回顾分析

Clinical Retrospective Analysis of Purulent Meningitis in Premature and Full-term Infants

目的:探讨足月儿、早产儿化脓性脑膜炎发病原因、临床表现及出院时情况,认识两组不同胎龄新生儿化脓性脑膜炎的临床特点,为临床诊疗提供依据。方法:回顾分析2017年6月-2018年2月福建省妇幼保健院新生儿科176例新生儿化脓性脑膜炎患儿的临床资料,按胎龄分为足月儿组、早产儿组,研究两组患儿发病原因、主要临床表现、相关检查(脑电图、头颅彩色普勒超声、CT、MRI)、并评估其出院时情况。结果:早产儿35例,足月儿141例。早产儿组母产前胎膜早破发生率高于足月儿组,差异有统计学意义(P=0.020)。早产儿组发病时间为第8.0(1.0,14.0)天,足月儿组发病时间为第13.0(7.0,20.0)天,差异有统计学意义(P=0.007)。早产儿组发热、惊厥、气促发生率分别为34.3%、0、54.3%,足月儿组分别为79.4%、14.9%、9.9%,差异均有统计学意义(P<0.001、=0.015、<0.001)。早产儿组脑脊液蛋白结果明显高于足月儿组,差异有统计学意义(P=0.001),早产儿组颅脑影像学结果阳性率明显高于足月儿组,差异有统计学意义(P=0.011)。早产儿组抗感染疗程明显长于足月儿组,差异有统计学意义(P=0.029);两组出院时情况比较差异无统计学意义(P=0.808)。结论:与足月儿感染化脓性脑膜炎相比,早产儿的发病时间更早,住院时间及抗感染疗程更长,临床表现更不典型,脑脊液蛋白数更高,颅脑影像学结果阳性率更高。

Objective:To investigate the pathogenic factors,clinical manifestations and discharge conditions of purulent meningitis in full-term infants and preterm infants,and to understand the clinical characteristics of purulent meningitis in neonates of different gestational ages in two groups,so as to provide basis for clinical diagnosis and treatment.Method:From June 2017 to February 2018,176 neonates with purulent meningitis in neonatal department of Fujian Maternal and Child Health Hospital were retrospectively analyzed.They were divided into two groups according to gestational age:full-term infants group and premature infants group.The pathogenesis factors,main clinical manifestations,relevart checks such as EEG,cranial color Doppler ultrasound,CT,MRI results and the short-term prognosis according to discharge status were studied between two groups.Result:There were 35 premature infants and 141 full-term infants.The incidence of premature rupture of fetal membranes in the premature infant group was higher than that in the full-term infant group,and the difference was statistically significant(P=0.020).The onset time of premature infants was the 8.1(1.0,14.0)days,and that of full-term infants was the 13.0(7.0,20.0)days,the difference was statistically significant(P=0.007).The incidence of fever,convulsion and shortness of breath was 34.3%,0 and 54.3%in the premature group.The incidence of fever,convulsion and breathlessness was 79.4%,14.9%and 9.9%in the full month group,and the differences were statistically significant(P<0.001,=0.015,<0.001).The CSF protein results of the premature infants group were significantly higher than those of the full-term infants group,with statistically significant difference(P=0.001),while the positive rate of the craniocerebral imaging results of the premature infants group was significantly higher than that of the full-term infants group,with statistically significant difference(P=0.011).The duration of anti-infection treatment in the premature infant group was significantly longer than that in full-term infants,and the difference was statistically significant(P=0.029).There was no significant difference between the two groups at discharge(P=0.808).Conclusion:Compared with full-term infants with purulent meningitis,premature infants had earlier onset time,longer hospital stay and anti-infection course,more atypical clinical manifestations,higher cerebrospinal fluid protein number,and higher positive rate of brain imaging results.