69例儿童流行性脑脊髓膜炎的临床特征及危险因素分析

目的 提高临床儿科医生对儿童流行性脑脊髓膜炎的诊治水平.方法 回顾性分析本院1999年至2011年收治的69例儿童流行性脑脊髓膜炎的发病时间、发病年龄、临床表现、实验室检查、治疗经过及预后情况.同时按类型把该组病例分为普通型和暴发型,进行危险因素分析.结果 发病年龄56 d ～15岁,平均（6.85＆#177;5.12）岁,其中＜6个月7例,～5岁30例,～10岁9例,≥10岁23例.男33例,女36例.发病时间1～5月份60例,6～10月份6例,11 ～ 12月份3例.普通型42例,全部治愈出院;暴发型27例,有7例死亡.所有患儿均急性起病伴有发热,皮肤瘀点瘀斑92.75％,头痛52.17％,呕吐71.01％,颈抵抗阳性94.20％,惊厥21.74％,嗜睡或昏迷50.72％,病理征阳性46.38％,血压下降、休克表现34.78％.血常规白细胞计数升高63.77％,下降8.70％;血小板计数下降42.03％;55.07％患儿有电解质紊乱;89,86％患儿有凝血功能异常,其中纤维蛋白原下降46.38％.皮疹印片和脑脊液涂片革兰染色检出革兰阴性双球菌阳性率分别为12.5％ （8/64）和19.35％ （12/62）;脑脊液培养阳性率为12.90％（8/62）,血培养阳性率为7.25％（5/69）.药敏显示青霉素、头孢曲松对细菌敏感.发病年龄、白细胞计数下降、血小板计数下降、纤维蛋白原下降、意识改变等指标在普通型和暴发型差异有统计学意义（P＜0.05）.结论 儿童流行性脑脊髓膜炎发病时间集中在1～5月份,年龄以5岁以下为主,儿童流行性脑脊髓膜炎的抗菌药首选青霉素和（或）头孢曲松,发病年龄、血小板计数下降、白细胞计数下降、纤维蛋白原下降、意识改变等指标可作为儿童流行性脑脊髓膜炎的危险因素推测病情的严重程度.

Clinical features and risk factors analysis on 69 children of epidemic cerebrospinal meningitis

Objective To improve the diagnosis and treatment of epidemic cerebrospinal meningitis in children.Methods A retrospective review was performed and a total of 69 cases of children epidemic cerebrospinal meningitis were collected and classified into ordinary and fulminant epidemic cerebrospinal meningitis from 1999 to 2011.Disease prevalent season,age,clinical characteristics,laboratory examination,treatment,prognosis and risk factors were analyzed.Results The mean age（33 male and 36 female） was （6.85 ＆#177;5.12）years old,ranging from 56 days to 15 years old.A total of 60 cases began on January to May; 6 cases began on June to October; 3 cases began on November to December.All of the 42 cases of ordinary epidemic meningitis were recovered; 7 cases of fulminant epidemic meningitis（n =27） were dead.All of the patients had fever; 64 cases（92.75%） had Petechiae petechial skin; 36 cases（52.17%） had headache; 49 cases（71.01%） vomited; 65 cases（94.2%） had positive neck resistance; 15 cases（21.74%） had convulsion; 35 cases（50.72%） had drowsiness or coma; 32 cases （46.38%） had positive pathological signs and 24 cases （34.78%） had low blood pressure or shock.Blood tests revealed that 63.77% of the patients leukocytes raised and 8.70% of the patients reduced; 42.03% of the patients platelet reduced; 55.07% of the patients had electrolyte disturbance and 89.86% of the patients had coagulation disorders,among which 46.38% fibrinogen reduced.The rash printed piece and cerebrospinal fluid smear tests found that Gram-negative bacteria positive rate were 12.5% and 19.35% respectively; the positive rate in bacterial culture of cerebrospinal fluid and blood culture were 12.90% and 7.25% respectively.Drug sensitive test showed that penicillin and ceftriaxone were sensitive to bacteria.The differences of age,leukocyte and platelet counts,fibrinogen and altered mental status between ordinary and fluminant epidemic meningitis were significant （P 〈 0.05）.Conclusion The prevalent season i