新生儿、小婴儿化脓性脑膜炎73例

目的探讨新生儿、小婴儿化脓性脑膜炎（化脑）的临床表现、转归及早期识别方法。方法对73例确诊为化脑的3个月龄以下婴儿进行回顾性分析。按照发病年龄分为新生儿、小婴儿组,对二组临床症状、惊厥发作类型、并感染情况、病原学检测结果、头颅影像学检查情况、并发症、感染项目检测结果及临床转归进行比较。结果新生儿、小婴儿化脑均以体温改变、精神反应异常、纳差、惊厥为主要表现,惊厥发作类型中新生儿组微小发作较婴儿组显著增多（P〈0.01）,婴儿组强直和阵挛型发作较新生儿显著增多（Pa〈0.01）;新生儿组并败血症者较婴儿组显著增多（P〈0.01）;小婴儿化脑并发症发生率较新生儿显著增高（P〈0.01）;婴儿组发生硬膜下积液者较新生儿组显著增多（P〈0.01）。二组预后不良患儿就诊时间较痊愈患儿就诊时间晚,有显著性差异（Pa〈0.01）。结论新生儿、小婴儿化脑危害严重,化脑的早期识别依赖于临床观察,及时脑脊液检查。婴儿易发生硬膜下积液。

Clinical Analysis of 73 Cases of Neonatal and Infantile Purulent Meningitis

Objective To explore the similarities and differences of clinical characteristics,prognosis of the neonatal and infantile purulent meningitis and the methods of early diagnosis.Methods Seventy-three cases of infantile purulent meningitis under 3 months were retrospectively analyzed. According to the ages, the cases were divided into neonatal group and infantile group. The clinical characteristics and the types of seizure,incorporated infection,pathogen,results of computed tomography,complications,laboratory indicators of infection and prognosis of two groups were compared. Results The most common clinical manifestations of neonatal and infantile purulent meningitis were hyperthermia or hypothermia,lathargy,unwillingness to breast-feed and seizure. Subtle seizure was found more often in neonatal group than that in infantile group(P<0.01). Tonic and clonic seizure were found more often in infantile group than those in neonatal group(Pa<0.01).More patients incorporated with sepsis in neonatal group than that in infantile group, and there was significant difference between two groups(P<0.01). Higher complication rate was found in infantile group (P<0.01). The interval of those whose outcome was adverse was longer than those whose outcome was good(Pa<0.01). Conclusions The damage of purulent meningitis is severe both in neonatal and infantile, early recognition is important. Close observation is the key to early recognition. Lumbar puncture shall be made as soon as possible. Subdural effusion is often seen in infantile patients.