新生儿重症化脓性脑膜炎与普通化脓性脑膜炎的对比分析

目的 探讨新生儿重症化脓性脑膜炎和普通化脓性脑膜炎的病原菌分布、临床特点及转归的不同，为临床早期鉴别重症化脓性脑膜炎，及时治疗和判断预后提供依据。 方法 选取2019年10月—2022年10月收治的135例新生儿化脓性脑膜炎病例，按病情严重程度分为重症组和普通组，回顾性收集临床资料，分析两组新生儿的临床症状体征、辅助检查及转归的差异。 结果 135例新生儿化脓性脑膜炎中，重症组60例，普通组75例。与普通组相比，重症组早产儿、低出生体重儿、出生窒息史所占比例以及胎膜早破发生率均增高(均P＜0.05)，反应差、惊厥、神志异常、呼吸增快、心率增快、低氧血症、血小板计数降低、肝功能损伤、肾功能损伤的发生率明显升高(均P＜0.05)。重症组脑脊液白细胞计数、蛋白质浓度高于普通组，脑脊液糖浓度低于普通组，并发症的发生率高于普通组(均P＜0.05)。反应差、肝功能损伤、低氧血症、脑脊液蛋白质浓度升高及脑脊液糖浓度降低是新生儿重症化脓性脑膜炎的独立危险因素。 结论 新生儿重症化脓性脑膜炎和普通化脓性脑膜炎在临床表现、实验室检查及并发症方面存在一定的差异，早期可以通过临床表现和实验室检查来鉴别新生儿重症化脓性脑膜炎，做到早期识别、积极治疗。

Comparison between severe purulent meningitis and moderate purulent meningitis in neonates

Objective To explore the difference of pathogenic bacteria distribution, clinical characteristics and prognosis between severe purulent meningitis and moderate purulent meningitis in neonates, provide evidences for the early identification, timely treatment and prognosis evaluation of severe purulent meningitis. Methods 135 cases of neonatal purulent meningitis admitted in a hospital from October 2019 to October 2022 were selected and divided into the severe group and the moderate group based on the severity condition. Clinical data were collected retrospectively. Differences in clinical symptoms, auxiliary examinations, and prognosis between the two groups of neonates were analyzed. Results Among 135 cases of neonatal purulent meningitis, 60 cases were in the severe group and 75 cases in the moderate group. Compared with the moderate group, the proportions of premature infants, low birth weight infants, birth asphyxia history, and the incidence of premature rupture of membranes in the severe group were all higher (all P < 0.05); the incidence of poor responsiveness, convulsion, abnormal consciousness, tachypnea, tachycardia, hypoxemia, thrombocytopenia, liver function damage, and kidney function damage in the severe group were all significantly higher (all P < 0.05). Compared with the moderate group, the white blood cell count and protein concentration of cerebrospinal fluid in the severe group were higher, glucose concentration of cerebrospinal fluid were lower, and the incidence of complications was higher (all P < 0.05). Poor response, liver function damage, hypoxemia, the increase of cerebrospinal fluid protein concentration and the decrease of glucose concentration of cerebrospinal fluid were independent risk factors for neonatal severe purulent meningitis. Conclusion There are differences in clinical manifestations, laboratory examinations and complications between patients with severe purulent meningitis and moderate purulent meningitis. Early identification and active treatment of neonatal severe purulent meningitis can be achieved through clinical symptoms and laboratory examinations, enabling timely recognition and intervention.