目的 探讨影响化脓性脑膜炎不良预后的危险因素.方法 对2007年1月-2008年12月在北京儿童医院感染病房临床诊断的化脓性脑膜炎148例患儿进行系统回顾分析,采用t检验和卡方检验及logistic回归分析方法,根据Glasgow临床结局评分标准比较预后良好组与预后不良组在病史、临床表现、并发症、辅助检查、治疗等方面的异同.结果 发热、精神反应差、抽搐是化脓性脑膜炎患儿最常见的临床表现,单变量回归分析提示住院时间、瞳孔对光反射减弱、瞳孔不等大、血白细胞计数＜4×109/L或＞12×109/L、脑脊液糖≤1.5 mmol/L、脑脊液蛋白＞1000 mg/L、血钠＜135mmol/L和血钙在两组间差异有统计学意义;而年龄、性别、抗生素应用、激素治疗等与预后无明显相关.多变量分析发现,住院时间、瞳孔不等大、入院时末梢血白细胞计数、脑脊液糖和蛋白水平、血钠对预后有指示意义.结论 影响化脓性脑膜炎不良预后的危险因素是瞳孔不等大、入院时白细胞计数＜4×109/L或＞12×109/L、脑脊液糖≤1.5 mmol/L、脑脊液蛋白＞1000 mg/L、血钠＜135 mmol/L.对有预后不良因素者进行更为积极有效的治疗可以在一定程度上改善其预后.%Objectives To investigate clinical features and risk factors for an adverse outcome of childhood bacterial meningitis.Methods A total of 148 bacterial meningitis patients admitted in Beijing Children's Hospital fron January 2007 to December 2008 were retrospectively analyzed.According to Glasgow prognostic score, all cases were divided ino two groups, favorable and adverse outcome groups.All risk factors including disease history, clinical manifestations, complications, laboratory examinations, and treatment were studied staistically and compared with two different groups.Results The most common clinical characteristics were fever, lethargy and convulsion.Of all studied risk factors, the length of stay in hospital, retardation of papillary reflex and anisocoria, the white blood cell count ( ＜ 4 × 109/L or＞ 12 × 109/L ), the cerebrospinal fluid sugar ( ＜ 1.5 mmol/L ) and protein ( ＞ 1 000 mg/L ), serum sodium ＜ 135 mmol/L and serum calcium were significantly different between two groups.Conclusions The risk factors for an adverse outcome of bacterial meningitis were anisocoria, abnormal blood white cell count at admission, cerebrospinal fluid low sugar and high protein level, and low serum sodium level.
展开▼
