咪达唑仑联合亚低温辅助治疗小儿化脓性脑膜炎的临床效果
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摘要
目的观察咪达唑仑联合亚低温辅助治疗小儿化脓性脑膜炎的疗效。方法将50例化脓性脑膜炎患儿随机分为观察组和对照组,每组25例。两组均给予常规治疗,观察组同时辅以咪达唑仑联合亚低温治疗。观察两组临床症状体征恢复正常所需时间、临床疗效。比较两组治疗前后血清C反应蛋白(CRP)、血乳酸、降钙素原水平以及脑脊液常规、格拉斯哥昏迷(GCS)评分。结果观察组患儿治疗有效率为88. 0%,高于对照组的60. 0%(P <0. 05)。观察组患儿的退热、意识恢复、抽搐消失、脑膜刺激征消失、锥体束征消失、肢体活动功能及脑脊液恢复正常所需时间均短于对照组(均P <0. 05)。治疗后,观察组患儿脑脊液压力、白细胞计数、蛋白含量以及血乳酸、CRP、降钙素水平均低于治疗前及对照组,脑脊液葡萄糖含量、GCS评分均高于治疗前及对照组(均P <0. 05)。结论咪达唑仑联合亚低温辅助治疗小儿化脓性脑膜炎疗效好,其可降低机体炎症反应,具有较好的脑保护作用。
Objective To observe the efficacy of adjunctive midazolam combined with subhypothermia in treating pediatric purulent meningitis. Methods Fifty children with purulent meningitis were randomly divided into observation group or control group,with 25 cases in each group. Both groups received routine treatment,with observation group treated additionally with auxillary midazolam and subhypothermia. Duration for the normalization of clinical symptoms and signs and the clinical efficacy in both groups were observed. Before and after treatment,levels of C-reactive protein( CRP),blood lactate and procalcitonin,routine test results of cerebrospinal fluid,and Glasgow Coma Scale( GCS)score were compared between the two groups. Results Therapeutic effective rate of the observation group was higher than that of the control group( 88. 00% vs. 60. 00%,P < 0. 05). Durations for normalization of temperature,recovery of consciousness,disappearance of convulsion,meningeal irritation sign and pyramidal sign,normalization of extremity motor and cerebrospinal fluid were all shorter in the observation group than in the control group( all P < 0. 05). After treatment,pressure,leukocyte count,protein content in the cerebrospinal fluid,the levels of blood lactate,CRP and procalcitonin decreased in the observation group and were lower than those in the control group; and glucose content and GCS score increased in the observation group and were higher than those in the control group( all P < 0. 05).Conclusion Adjunctive midazolam combined with subhypothermia can obtain a good efficacy in treating pediatric purulent meningitis,for it can reduce the inflammatory reaction of bodies,and has a better protective effect on brain.
Objective To observe the efficacy of adjunctive midazolam combined with subhypothermia in treating pediatric purulent meningitis. Methods Fifty children with purulent meningitis were randomly divided into observation group or control group,with 25 cases in each group. Both groups received routine treatment,with observation group treated additionally with auxillary midazolam and subhypothermia. Duration for the normalization of clinical symptoms and signs and the clinical efficacy in both groups were observed. Before and after treatment,levels of C-reactive protein( CRP),blood lactate and procalcitonin,routine test results of cerebrospinal fluid,and Glasgow Coma Scale( GCS)score were compared between the two groups. Results Therapeutic effective rate of the observation group was higher than that of the control group( 88. 00% vs. 60. 00%,P < 0. 05). Durations for normalization of temperature,recovery of consciousness,disappearance of convulsion,meningeal irritation sign and pyramidal sign,normalization of extremity motor and cerebrospinal fluid were all shorter in the observation group than in the control group( all P < 0. 05). After treatment,pressure,leukocyte count,protein content in the cerebrospinal fluid,the levels of blood lactate,CRP and procalcitonin decreased in the observation group and were lower than those in the control group; and glucose content and GCS score increased in the observation group and were higher than those in the control group( all P < 0. 05).Conclusion Adjunctive midazolam combined with subhypothermia can obtain a good efficacy in treating pediatric purulent meningitis,for it can reduce the inflammatory reaction of bodies,and has a better protective effect on brain.
引文
[1]林振秀,陈嘉蕾,王世平,等.儿童早期预警评分在神经内科中的临床应用[J].实用医学杂志,2017,33(8):1 294-1 297.
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[9]辛静,徐曼.儿童化脓性脑膜炎近期不良预后危险因素分析[J].中南医学科学杂志,2016,44(6):657-660.
[10]刘胜利.亚低温治疗对急诊心脏骤停复苏后优化治疗的疗效分析[J].临床和实验医学杂志,2016,15(15):1 537-1 539.
[11]陈胜,闵红叶,周书琴,等.亚低温对脑缺血再灌注损伤大鼠神经细胞凋亡和caspase-3释放的影响[J].同济大学学报:医学版,2016,37(6):18-22,34.
[12]魏亮,王琦,杨成,等.亚低温辅助治疗对高血压颅内出血患者炎性细胞因子水平,脑血肿及脑水肿的影响[J].广西医学,2018,40(3):253-255.
[13]陈锋,张芙蓉,孙继民,等.亚低温对重症病毒性脑炎患儿血清及脑脊液NSE、S100B蛋白表达的影响[J].华中科技大学学报(医学版),2017,46(3):291-294.
[14]汪江,杨亚东,佘秋芳,等.亚低温对重型颅脑损伤患者脑氧代谢及脑损伤程度的影响[J].海南医学院学报,2018,24(1):133-137.
[15]徐萍,郑瑞强,欧晓峰,等.咪达唑仑对中重型颅脑损伤患者炎性介质的影响[J].中国中西医结合急救杂志,2017,24(2):162-197.
[16]杜东海,石凯丽,闫敏,等.大肠埃希菌致新生儿细菌性脑膜炎22例临床分析[J].山西医科大学学报,2016,48(4):378-381.
[17]崔福生,王秀锋,孙瑞雪.小儿化脓性脑膜炎的临床特点及MRI影像学表现分析[J].贵州医药,2017,41(12):1 311-1 313.
[18]刘淑华,刘翠青,马莉,等.新生儿化脓性脑膜炎脑脊液变化特点分析[J].中国小儿急救医学,2015,22(7):470-473.
[19]李欣,张春野,汪麟.局部亚低温辅助治疗对老年急性脑出血患者应激激素及应激性疾病的影响[J].中国老年学杂志,2015,13(13):3 568-3 570.
[20]罗卉丽,王刚,陈光治,等.降钙素原与超敏C反应蛋白联合检测在儿童中枢神经系统感染性疾病中的临床价值[J].国际检验医学杂志,2015,36(2):209-210.
[21]周国云.脑脊液和血浆生化指标比值对结核性及化脓性脑膜炎的鉴别意义[J].海南医学院学报,2018,24(2):191-194.
[22]陈婷婷.化脓性脑膜炎患儿血液神经元特异性烯醇化酶,乳酸水平检测的临床应用价值[J].中华临床医师杂志(电子版),2017,11(7):1 107-1 109.
[23]董立.脑脊液降钙素原及乳酸脱氢酶动态测定在小儿化脓性脑膜炎中诊疗的应用[J].中华实验和临床感染病杂志(电子版),2014,8(6):812-814.
[24]许巍,尹苗,王丽杰,等.儿童重症化脓性脑膜炎CD3+CD8+T细胞与炎症指标、体液免疫的变化[J].中国小儿急救医学,2017,24(1):39-43.
[2]毛丹丹,廖建湘,蒋莉.辅助检查对化脓性脑膜炎并硬膜下积液患儿的诊断价值[J].中华实用儿科临床杂志,2015,30(19):1 497-1 500.
[3]江载芳,申昆玲,沈颖.诸福棠实用儿科学[M]. 8版.北京:人民卫生出版社,2015:981-1 003.
[4]王汉斌,华春珍,李建平. 2007-2014年儿童脑脊液培养病原菌分布及耐药性分析[J].临床儿科杂志,2016,34(7):533-537.
[5]范秋霞.降钙素原在婴幼儿化脓性脑膜炎早期诊断中的意义[J].中国实用神经疾病杂志,2017,20(14):76-78.
[6]范惠先,任朝杰,王润青.脑脊液检查在中枢神经系统感染性疾病鉴别中的应用[J].医学综述,2015,21(7):1 294-1 295.
[7] Qian Y,Wong CC,Lai SC,et al. Klebsiella pneumoniae invasive liver abscess syndrome with purulent meningitis and septic shock:a case from mainland China[J]. World J Gastroenterol,2016,22(9):2 861-2 866.
[8]仇世蓉.小儿化脓性脑膜炎的诊断和治疗进展[J].中国实用医药,2016,11(17):283-284.
[9]辛静,徐曼.儿童化脓性脑膜炎近期不良预后危险因素分析[J].中南医学科学杂志,2016,44(6):657-660.
[10]刘胜利.亚低温治疗对急诊心脏骤停复苏后优化治疗的疗效分析[J].临床和实验医学杂志,2016,15(15):1 537-1 539.
[11]陈胜,闵红叶,周书琴,等.亚低温对脑缺血再灌注损伤大鼠神经细胞凋亡和caspase-3释放的影响[J].同济大学学报:医学版,2016,37(6):18-22,34.
[12]魏亮,王琦,杨成,等.亚低温辅助治疗对高血压颅内出血患者炎性细胞因子水平,脑血肿及脑水肿的影响[J].广西医学,2018,40(3):253-255.
[13]陈锋,张芙蓉,孙继民,等.亚低温对重症病毒性脑炎患儿血清及脑脊液NSE、S100B蛋白表达的影响[J].华中科技大学学报(医学版),2017,46(3):291-294.
[14]汪江,杨亚东,佘秋芳,等.亚低温对重型颅脑损伤患者脑氧代谢及脑损伤程度的影响[J].海南医学院学报,2018,24(1):133-137.
[15]徐萍,郑瑞强,欧晓峰,等.咪达唑仑对中重型颅脑损伤患者炎性介质的影响[J].中国中西医结合急救杂志,2017,24(2):162-197.
[16]杜东海,石凯丽,闫敏,等.大肠埃希菌致新生儿细菌性脑膜炎22例临床分析[J].山西医科大学学报,2016,48(4):378-381.
[17]崔福生,王秀锋,孙瑞雪.小儿化脓性脑膜炎的临床特点及MRI影像学表现分析[J].贵州医药,2017,41(12):1 311-1 313.
[18]刘淑华,刘翠青,马莉,等.新生儿化脓性脑膜炎脑脊液变化特点分析[J].中国小儿急救医学,2015,22(7):470-473.
[19]李欣,张春野,汪麟.局部亚低温辅助治疗对老年急性脑出血患者应激激素及应激性疾病的影响[J].中国老年学杂志,2015,13(13):3 568-3 570.
[20]罗卉丽,王刚,陈光治,等.降钙素原与超敏C反应蛋白联合检测在儿童中枢神经系统感染性疾病中的临床价值[J].国际检验医学杂志,2015,36(2):209-210.
[21]周国云.脑脊液和血浆生化指标比值对结核性及化脓性脑膜炎的鉴别意义[J].海南医学院学报,2018,24(2):191-194.
[22]陈婷婷.化脓性脑膜炎患儿血液神经元特异性烯醇化酶,乳酸水平检测的临床应用价值[J].中华临床医师杂志(电子版),2017,11(7):1 107-1 109.
[23]董立.脑脊液降钙素原及乳酸脱氢酶动态测定在小儿化脓性脑膜炎中诊疗的应用[J].中华实验和临床感染病杂志(电子版),2014,8(6):812-814.
[24]许巍,尹苗,王丽杰,等.儿童重症化脓性脑膜炎CD3+CD8+T细胞与炎症指标、体液免疫的变化[J].中国小儿急救医学,2017,24(1):39-43.