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目的:探讨影响新生儿化脓性脑膜炎预后不良的危险因素。方法:对2011年1月至2014年1月深圳市儿童医院新生儿科诊断为化脓性脑膜炎的73例患儿进行回顾性分析,根据临床预后分为预后良好组与预后不良组,比较两组患儿病史、临床表现、并发症、辅助检查、治疗等。结果:预后良好组50例,预后不良组23例。预后良好组和预后不良组脑脊液蛋白中位数(P50)分别为2 116 mg/L、3 065 mg/L,脑脊液糖P50分别为1.36 mmol/L、1.00 mmol/L,脑脊液乳酸脱氢酶P50分别为70.0 U/L、127.0 U/L,两组比较差异均有统计学意义(P均<0.05);两组抽搐、前囟改变、意识改变、瞳孔改变的例数分别为16例、14例、13例、18例和14例,14例、13例、16例,差异有统计学意义(P均<0.05);两组患儿年龄、住院时间、入院时体质量、入院时间、体温和外周血白细胞、降钙素原、CRP、外周血血红蛋白水平以及代谢性酸中毒、低钠血症、低蛋白血症、血小板减少、黄疸、呼吸道症状、消化道症状、肌张力、原始反射、病原学检测、是否使用激素等例数比较差异均无统计学意义(P均>0.05)。结论:影响新生儿化脓性脑膜炎不良预后的危险因素主要是意识水平降低、抽搐、前囟张力高、瞳孔对光反射不灵敏或瞳孔不等大等圆;预后不良的患儿在脑脊液的常规检查及生化检查中异常的更为明显。
Objective: To explore the risk factors affecting the poor prognosis of neonatal purulent meningitis. Methods: From January 2011 to January 2014, Shenzhen Children’s Hospital neonatal diagnosis of purulent meningitis in 73 cases of children were analyzed retrospectively, according to clinical prognosis is divided into good prognosis group and poor prognosis group, compared two groups Children’s medical history, clinical manifestations, complications, laboratory examinations and treatment. Results: The prognosis was good in 50 cases, poor prognosis in 23 cases. The median (CSF) protein concentrations of CSF with good prognosis and poor prognosis were 2 116 mg / L and 3 065 mg / L, respectively. The P50 values of cerebrospinal fluid were 1.36 mmol / L and 1.00 mmol / L respectively. Cerebrospinal fluid lactate dehydrogenase P50 Were 70.0 U / L and 127.0 U / L, respectively, with significant difference between the two groups (all P <0.05). The number of convulsions, anterior fontanel, change of consciousness and pupil changes in the two groups were 16 and 14 13 cases, 18 cases and 14 cases, 14 cases, 13 cases and 16 cases, the difference was statistically significant (P all <0.05). The age, hospitalization time, body mass on admission, And peripheral blood leukocytes, procalcitonin, CRP, peripheral blood hemoglobin levels and metabolic acidosis, hyponatremia, hypoalbuminemia, thrombocytopenia, jaundice, respiratory symptoms, gastrointestinal symptoms, muscle tone, There was no significant difference in the number of pathogenic tests, whether or not to use hormones (P> 0.05). Conclusion: The risk factors affecting the adverse prognosis of neonatal purulent meningitis are mainly the reduction of consciousness level, convulsions, high anterior fontanel, insensitivity of pupil to light reflex or unequal pupil, etc. The poor prognosis in children with cerebrospinal fluid Abnormal examination and biochemical tests even more obvious.