317 例儿童化脓性脑膜炎临床分析

Clinical analysis of purulent meningitis in 317 children

摘要:

目的 研究化脓性脑膜炎(PM)患儿的临床特点及治疗转归。方法 对317 例年龄在1 个月至15 岁的PM 患儿的病例资料进行回顾性分析。结果 PM 发病以婴儿(198 例,62.6%)居多,多有呼吸道前驱感染(171 例,53.9%)。临床以发热、惊厥、颅内高压为主要表现,惊厥在婴儿中发生率较高(152 例,93.6%)。主要并发症为硬膜下积液(95 例,29.9%),其中22 例头颅影像学未提示而直接通过硬膜下穿刺诊断;68 例行硬膜下穿刺,其中62 例于穿刺后3~5 d 内体温恢复正常。多因素logisic 回归分析显示,年龄、CSF蛋白≥ 1 g/L 是影响PM 患儿并发症和后遗症发生的主要因素(分别OR=0.518、1.524,均P<0.05)。治疗上初诊时以第三代头孢为首选用药,万古霉素、碳青霉烯类可作为替代。在对部分患儿出院后1~3 个月的随访发现,14.4%(13/90)发生延迟血管炎反应。结论 PM 多发于婴儿,惊厥在婴儿中易发生。小婴儿、CSF 蛋白≥ 1 g/L 时会增加PM 患儿并发症和后遗症的发生风险。硬膜下穿刺对硬膜下积液的诊断及治疗均有价值。部分治愈患儿存在延迟血管炎反应,应在出院后1~3 个月内进行随访。

Abstract:

Objective To study the clinical features, treatment, and prognosis of purulent meningitis (PM) in children. Methods A retrospective analysis was performed on the clinical data of 317 children with PM aged from 1 month to 15 years. Results PM was commonly seen in infants (198 cases, 62.6%). Most children with PM had preceding respiratory infection (171 cases, 53.9%). The major clinical manifestations of PM were fever, convulsions, and intracranial hypertension, and convulsions were more commonly seen in infants (152 cases, 93.6%). The major complication was subdural effusion (95 cases, 29.9%). Of the 95 cases of subdural effusion, 22 cases were diagnosed by subdural puncture; 68 cases underwent subdural puncture and 62 cases restored to normal temperature 3-5 days after puncture. Risk factors associated with complications and sequelae were young age and protein ≥1 g/L in cerebrospinal fluid (CSF) (OR=0.518, 1.524 respectively; P<0.05). The third-generation cephalosporins were the first choice for PM, and vancomycin or carbapenems were replacement therapy. Thirteen (14.4%) out of 90 children had delayed cerebral vasculitis during a follow-up visit within 3 months after discharge. Conclusions PM is more commonly seen in infants, and the infants have a high incidence of convulsions. Young age and protein ≥1 g/L in CSF may increase the risk of complications and sequelae. Subdural puncture is not only a diagnostic method but also a therapy for subdural effusion. Some children have delayed cerebral vasculitis during a follow-up visit within 3 months after discharge, so follow-up visits should be performed within 3 months after discharge.