小儿化脓性脑膜炎临床和病因学分析

目的探讨化脓性脑膜炎的病因,为诊治提供科学依据。方法收集住院化脓性脑膜炎患儿371例,男252例,女119例;平均年龄(2.67±3.32)岁。对患儿临床表现及血液和脑脊液(CSF)相关参数进行分析。结果 371例中≤1岁患儿占46.36%,<3岁占80.59%,以发热(90.29%)、抽搐(52.56%)等症状就诊。82.21%患儿白细胞计数(WBC)>10×109/L,74.42%患儿中性粒细胞比率>50%,85.44%患儿脑脊液WBC≥500×106/L。血培养革兰染色阳性(GSP)37例,革兰阳性菌(GPB)24例,革兰阴性菌(GNB)13例。脑脊液培养阳性34例,GPB 19例,GNB 15例。脑脊液检测出肺炎链球菌8例,流感嗜血杆菌3例,奈瑟菌1例。死亡7例(1.88%)中,脑脊液2例GNB阳性,5例化脓性/混浊,4例蛋白>150 mg/dl和葡萄糖<1 mg/dl。结论化脓性脑膜炎的发病年龄多在婴幼儿阶段,临床表现多种多样,血液和脑脊液相关参数分析,能较好的提供病因诊断依据,并为临床治疗及预后提供参考。

Clinical features and etiology of childhood purulent meningitis

Objective To explore the etiology of purulent meningitis in children to provide scientific basis for diagnosis and treatment.Methods Collected 371 cases diagnosed as purulent meningitis including 252 of male and 119 of female.The average age of patients was(2.67 ± 3.32)years old.The clinical features,parameters of blood and cerebrospinal fluid(CSF)were analyzed.Results Infants(≤ 1 y)accounted for 46.36%,1-3 year children accounted for 80.59%.The clinical manifestations of patients mainly were fever(90.29%)and seizures(52.56%).White blood cell(WBC)accounts were more than 10 × 109/L in 82.21% of patients,neutrophils ratio > 50% in 74.42% of patients and WBC in CSF ≥ 500 × 106/L in 85.44% of cases.Blood culture of 37 cases were indicative of gram staining positive(GSP)including 24 cases of gram-positive bacteria(GPB)and 13 cases of gram-negative bacteria(GNB).CSF culture of 34 cases of GSP showed 19 cases of GPB and 15 cases of GNB.Streptococcus pneumonias were detected in 8 patients’CSF,Haemophilus influenzas in 3 cases and Neisseria meningitides in one case.Seven patients deceased,2 of them had GNB positive in CSF and 5 of them showed purulent opacity.CSF protein was more than 150 mg/dl in 4 cases and glucose was found less than 1 mg/dl in the other 4 cases.Conclusions Purulent meningitis mostly happens in infantile period with variety of clinical manifestations.The parameters of blood and cerebrospinal fluid analysis can provide basis for diagnosis and reference for treatment and prognosis.