新生儿不同病原菌化脓性脑膜炎临床分析

摘要

Objective To explore the clinical characteristics of purulent meningitis caused by different pathogens in neonates. Methods Clinical data of 172 cases of neonatal purulent meningitis from January 1, 2011 to December 31, 2012 were retrospectively analyzed. Results Cerebrospinal lfuid (CSF) appeared turbid and purulent in 54 cases (31.4%). The CSF cultures showed positive in 70 cases (40.7%), and Escherichia coli (E. coli) and staphylococcus were common. Thirty-one patients had complications (18.0%), among whom, 14 patients (8.1%) were complicated by hydrocephalus. Among E. coli meningitis group, other pathogens group and unknown pathogens group, there were signiifcant differences in the rate of abnormal CSF appearance, CSF white blood cell counts, the rate of CSF white blood cell counts greater than 500×106/L, the levels of sugar and protein in CSF, duration of fever, the time of CSF return to normal, length of hospital stay and cost, complication and case-fatality rate (all P<0.05). Conclusions When CSF appears turbid and purulent, especially when CSF white blood cell counts are greater than 500×106/L, E. coli infection should be considered. The purulent meningitis caused by E. coli has high occurrence rates of compli-cation and case-fatality and poor prognosis.%目的：探讨新生儿不同病原菌化脓性脑膜炎的临床特征。方法回顾性分析2011年1月1日至2012年12月31日172例新生儿化脓性脑膜炎患儿的临床资料。结果脑脊液外观浑浊和脓性54例(31.4%)；脑脊液培养阳性70例(40.7%)，以大肠埃希菌、葡萄球菌为主；并发症31例(18.0%)，其中脑积水14例(8.1%)。大肠埃希菌脑膜炎组与其他病原菌组、不明病原菌组比较，脑脊液外观异常比例、脑脊液白细胞计数、脑脊液白细胞计数>500×106/L比例、脑脊液糖和蛋白水平、发热持续时间、脑脊液恢复正常时间、住院时间和费用、并发症和死亡的比例差异有统计学意义(P均<0.05)。结论对于脑脊液外观呈浑浊和脓性，尤其脑脊液白细胞数>500×106/L时，需重点考虑大肠埃希菌感染可能，其并发症多、病死率高，预后相对较差。