大肠埃希菌感染所致新生儿化脓性脑膜炎的临床特征及预后分析
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摘要
目的分析大肠埃希菌感染所致新生儿化脓性脑膜炎的临床特征及预后。方法选择2013年4月—2015年3月河南省濮阳市妇幼保健院收治的化脓性脑膜炎患儿169例,按照脑脊液培养结果分为大肠埃希菌组(n=24)、其他细菌组(n=41)及病原菌不明组(n=104)。回顾性分析3组患儿住院期间和出院后3个月的临床资料和随访资料,比较3组患儿脑脊液透明度、白细胞计数、蛋白及糖含量,脑脊液恢复正常时间,发热持续时间,住院时间,住院费用,并发症发生率和病死率。结果其他细菌组和病原菌不明组患儿脑脊液透明度优于大肠埃希菌组(u值分别为25.162、22.170,P<0.05)。大肠埃希菌组患儿脑脊液白细胞计数、白细胞计数>500×106/L所占比例及蛋白含量均高于其他细菌组和病原菌不明组,糖含量低于其他细菌组和病原菌不明组(P<0.05)。大肠埃希菌组患儿脑脊液恢复正常时间、发热持续时间、住院时间长于其他细菌组和病原菌不明组,住院费用高于其他细菌组和病原菌不明组(P<0.05)。大肠埃希菌组患儿并发症发生率和病死率高于其他细菌组和病原菌不明组(P<0.05)。结论大肠埃希菌感染所致新生儿化脓性脑膜炎发热持续时间长、脑脊液蛋白含量和白细胞计数升高明显、糖含量降低,预后较差。
Objective To analyze the clinical features and prognosis of neonatal purulent meningitis caused by Escherichia Coli infection. Methods A total of 169 infants with purulent meningitis were selected in Maternity and Child Care Center of Puyang from April 2013 to March 2015,and they were divided into A group( caused by caused by Escherichia Coli infection,n = 24), B group( caused by non-Escherichia Coli infection, n = 41) and C group( caused by unknown pathogenic bacteria infection,n = 104) according to cerebrospinal fluid culture results. Clinical data during hospitalization and follow-up information after 3 months of discharge were retrospectively analyzed, transparency, WBC, protein and sugar content, recovery time of cerebrospinal fluid, fever duration, hospital stays, hospitalization expenses, incidence of complications and fatality rate were compared among the three groups. Results The cerebrospinal fluid transparency of B group and C group was statistically significantly better than that of A group,respectively( u = 25. 162,22. 170,P < 0. 05). WBC,proportion of WBC > 500 × 106/ L and protein content of cerebrospinal fluid of A group were statistically significantly higher than those of B group and C group,while sugar content of A group was statistically significantly lower than that of B group and C group,respectively( P < 0. 05). Cerebrospinal fluid recovery time, fever duration and hospital stays of A group were statistically significantly longer than those of B group and C group, and hospitalization expenses of A group was statistically significantly higher than that of B group and C group,respectively( P < 0. 05). The incidence of complications and fatality rate of A group were statistically significantly higher than that of B group and C group( P < 0. 05). Conclusion The fever duration of neonatal purulent meningitis caused by Escherichia Coli infection is long,the cerebrospinal fluid WBC and protein content are obviously increased,while the sugar content is obviously decreased,the prognosis is poor.
Objective To analyze the clinical features and prognosis of neonatal purulent meningitis caused by Escherichia Coli infection. Methods A total of 169 infants with purulent meningitis were selected in Maternity and Child Care Center of Puyang from April 2013 to March 2015,and they were divided into A group( caused by caused by Escherichia Coli infection,n = 24), B group( caused by non-Escherichia Coli infection, n = 41) and C group( caused by unknown pathogenic bacteria infection,n = 104) according to cerebrospinal fluid culture results. Clinical data during hospitalization and follow-up information after 3 months of discharge were retrospectively analyzed, transparency, WBC, protein and sugar content, recovery time of cerebrospinal fluid, fever duration, hospital stays, hospitalization expenses, incidence of complications and fatality rate were compared among the three groups. Results The cerebrospinal fluid transparency of B group and C group was statistically significantly better than that of A group,respectively( u = 25. 162,22. 170,P < 0. 05). WBC,proportion of WBC > 500 × 106/ L and protein content of cerebrospinal fluid of A group were statistically significantly higher than those of B group and C group,while sugar content of A group was statistically significantly lower than that of B group and C group,respectively( P < 0. 05). Cerebrospinal fluid recovery time, fever duration and hospital stays of A group were statistically significantly longer than those of B group and C group, and hospitalization expenses of A group was statistically significantly higher than that of B group and C group,respectively( P < 0. 05). The incidence of complications and fatality rate of A group were statistically significantly higher than that of B group and C group( P < 0. 05). Conclusion The fever duration of neonatal purulent meningitis caused by Escherichia Coli infection is long,the cerebrospinal fluid WBC and protein content are obviously increased,while the sugar content is obviously decreased,the prognosis is poor.
引文
[1]廖红梅,杨赛,陈枚,等.小儿化脓性脑膜炎临床和病因学分析[J].临床儿科杂志,2012,30(8):767-769.
[2]李小玉,邓春,苏云娟.98例足月儿、早产儿化脓性脑膜炎临床分析[J].第三军医大学学报,2013,35(19):2105-2107.
[3]Kepa L,Oczko-Grzesik B,Boroń-Kaczmarska A.Cerebrospinal fluid interleukin-6 concentration in patients with purulent,bacterial meningitis-own observations[J].Przegl Epidemiol,2014,68(4):645-649.
[4]郭在晨.小儿不典型细菌性脑膜炎、结核性脑膜炎及病毒性脑炎的鉴别诊断[J].医学临床研究,2004,21(11):1219-1222.
[5]张静,毛健,李娟,等.新生儿不同病原菌化脓性脑膜炎在磁共振影像学上的特点[J].中国当代儿科杂志,2012,14(07):489-495.
[6]刘瑛,刁玉霞,鞠秀明,等.新生儿化脓性脑膜炎的早期临床特征[J].中国妇幼保健,2012,27(10):1481-1483.
[7]张红爱,张惠芳,于淑群.新生儿化脓性脑膜炎的临床特点与早期诊断[J].实用儿科临床杂志,2012,27(14):1091-1092.
[8]张晓莉,贾天明,牛国辉,等.氯霉素治疗小儿难治性化脓性脑膜炎的疗效和安全性分析[J].中国妇幼保健,2014,29(8):1281-1283.
[9]程春旭,杨立彬,张舒石,等.应用布拉氏酵母菌预防儿童化脓性脑膜炎治疗中真菌感染的观察[J].中国妇幼保健,2013,28(27):4544-4546.
[10]朱敏丽,麦菁芸,朱将虎,等.大肠埃希菌致新生儿化脓性脑膜炎31例临床分析[J].中国当代儿科杂志,2012,14(12):910-912.
[11]Braun V,Eskens U,Hartmann A,et al.Focal bacterial meningitis following ascending bite wound infection leading to paraparesis in a captive California sea lion(Zalophus californianus)[J].J Zoo Wildl Med,2015,46(1):135-140.
[12]胡月圆,高喜容,占彩霞,等.新生儿不同病原菌化脓性脑膜炎临床分析[J].临床儿科杂志,2015,33(1):13-16.
[13]龚细礼,黄立,杜芬.隐球菌脑膜炎34例临床分析[J].医学临床研究,2008,25(2):283-284.
[14]Baba H,Sato Y,Toyonaga Y,et al.Nationwide survey of the development of drug resistance in the pediatric field in 2007,2010,and 2012:Drug sensitivity of Haemophilus influenzae serotype b strain in Japan[J].Infect Chemother,2015,21(4):277-283.
[15]丁翔宇,张古英,李成玲,等.抗菌药物治疗儿童化脓性脑膜炎的成本-效果分析[J].医药导报,2015,34(1):47-50.
[2]李小玉,邓春,苏云娟.98例足月儿、早产儿化脓性脑膜炎临床分析[J].第三军医大学学报,2013,35(19):2105-2107.
[3]Kepa L,Oczko-Grzesik B,Boroń-Kaczmarska A.Cerebrospinal fluid interleukin-6 concentration in patients with purulent,bacterial meningitis-own observations[J].Przegl Epidemiol,2014,68(4):645-649.
[4]郭在晨.小儿不典型细菌性脑膜炎、结核性脑膜炎及病毒性脑炎的鉴别诊断[J].医学临床研究,2004,21(11):1219-1222.
[5]张静,毛健,李娟,等.新生儿不同病原菌化脓性脑膜炎在磁共振影像学上的特点[J].中国当代儿科杂志,2012,14(07):489-495.
[6]刘瑛,刁玉霞,鞠秀明,等.新生儿化脓性脑膜炎的早期临床特征[J].中国妇幼保健,2012,27(10):1481-1483.
[7]张红爱,张惠芳,于淑群.新生儿化脓性脑膜炎的临床特点与早期诊断[J].实用儿科临床杂志,2012,27(14):1091-1092.
[8]张晓莉,贾天明,牛国辉,等.氯霉素治疗小儿难治性化脓性脑膜炎的疗效和安全性分析[J].中国妇幼保健,2014,29(8):1281-1283.
[9]程春旭,杨立彬,张舒石,等.应用布拉氏酵母菌预防儿童化脓性脑膜炎治疗中真菌感染的观察[J].中国妇幼保健,2013,28(27):4544-4546.
[10]朱敏丽,麦菁芸,朱将虎,等.大肠埃希菌致新生儿化脓性脑膜炎31例临床分析[J].中国当代儿科杂志,2012,14(12):910-912.
[11]Braun V,Eskens U,Hartmann A,et al.Focal bacterial meningitis following ascending bite wound infection leading to paraparesis in a captive California sea lion(Zalophus californianus)[J].J Zoo Wildl Med,2015,46(1):135-140.
[12]胡月圆,高喜容,占彩霞,等.新生儿不同病原菌化脓性脑膜炎临床分析[J].临床儿科杂志,2015,33(1):13-16.
[13]龚细礼,黄立,杜芬.隐球菌脑膜炎34例临床分析[J].医学临床研究,2008,25(2):283-284.
[14]Baba H,Sato Y,Toyonaga Y,et al.Nationwide survey of the development of drug resistance in the pediatric field in 2007,2010,and 2012:Drug sensitivity of Haemophilus influenzae serotype b strain in Japan[J].Infect Chemother,2015,21(4):277-283.
[15]丁翔宇,张古英,李成玲,等.抗菌药物治疗儿童化脓性脑膜炎的成本-效果分析[J].医药导报,2015,34(1):47-50.