大肠埃希菌致新生儿细菌性脑膜炎22例临床分析

摘要

目的 探讨大肠埃希菌致新生儿细菌性脑膜炎的临床特点、治疗及转归. 方法 对2011-03~2016-01山西省儿童医院收治的22例新生儿大肠埃希菌脑膜炎患儿的临床资料及转归进行回顾性分析. 结果 22例新生儿大肠埃希菌脑膜炎主要表现为反应差、发热、进奶差、黄疸等.共17例患儿化验脑脊液乳酸和乳酸脱氢酶,其中升高者分别为15例(88.24%)和14例(63.64%).共14例患儿出现了不同程度的并发症,其中并发低钠血症6例,硬膜下积液4例,颅内出血、呼吸衰竭各3例,脑室管膜炎、脑积水、心力衰竭各2例,脑脓肿、休克各1例.治愈7例(31.82%),好转8例(36.36%),未愈7例(31.82%)(其中死亡1例). 结论 新生儿大肠埃希菌脑膜炎临床表现缺乏特异性,预后欠佳,脑脊液乳酸和乳酸脱氢酶检测对该病有一定的早期诊断价值.早期明确诊断,尽快完善相关检查并根据药敏试验及时调整抗生素是提高治愈率、改善预后的关键.%Objective To analyze the clinical features,treatment and outcome of neonatal bacterial meningitis caused by Escherichia coli.Methods The medical record,treatment scheme and outcome of 22 neonates with bacterial meningitis caused by Escherichia coli(E.Coli)in Children's Hospital of Shanxi Province from March 2011 to January 2016 were retrospectively analyzed.Results Lethargy,fever,poor feeding and jaundice were the common clinical signs of these neonatal bacterial meningitis caused by Escherichia coli.Of 17 patients,15 patients had elevated lactic acid in cerebrospinal fluid and 14 cases had elevated lactic acid dehydrogenase level.There were 14 cases of acute complications,including 6 cases of hyponatremia,4 cases of subdural effusion,3 cases of intracranial hemorrhage,3 cases of respiratory failure,2 cases of ependymitis,2 cases of hydrocephalus,2 cases of heart failure,one case of encephalopyosis and one case of shock.Of the 22 patients,7 patients(31.82%)were cured, 8(36.36%)were improved,and 7(31.82%)were not cured(1 case died during hospitalization).Conclusion The clinical manifestations of neonatal bacterial meningitis caused by Escherichia coli are usually lack of specificity,and the outcome is poor.Lactic acid and lactic dehydrogenase in cerebrospinal fluid have refe-rence value for early detection of neonatal bacterial meningitis.To early diagnose,perform relevant checks as soon as possible,and adjust antibiotics based on susceptibility tests are essential to improve the cure rate and the prognosis.