小儿化脓性脑膜炎66例诊疗分析

目的    总结小儿化脓性脑膜炎的诊疗现状，为明确诊断、管理治疗提供参考。方法    对2008年1月至2010年4月复旦大学附属儿科医院神经科住院诊治的66例化脓性脑膜炎患儿临床与辅助检查资料进行回顾性分析。66例年龄范围30 d至11岁，中位数6个月。其中婴儿47例（71.2%）、幼儿11例（16.7%）、学龄前期5例（7.6%），学龄期3例（4.5%）。采用自定义诊断层面进行比较及总结。结果    66例中有前驱感染者37例（56.1%），有易感因素者6例（9.1%）。根据自定义诊断层面，病原学诊断明确者22例（33.3%）、临床符合诊断者33例（50.0%）、临床可能诊断者11例（16.7%）。原始脑脊液病原阳性率（62.5%）高于治疗后脑脊液（29.8%），原始脑脊液白细胞（WBC）异常升高比例（100.0%）亦高于治疗后脑脊液（91.2%），差异均有统计学意义（P＜0.05）。原始脑脊液和治疗后脑脊液相比，糖和蛋白差异无统计学意义（P＞0.05）。预后：临床治愈或好转53例（80.3%）、未愈13例（19.7%）。临床治愈或好转者平均疗程21 d（范围5～56 d）。常见并发症为硬膜下积液、听力损害、脑积水、硬膜下积脓等。结论      化脓性脑膜炎仍是婴幼儿最常见的急性危重病之一，结合临床定义的不同诊断层面有助于治疗管理。

The analysis of diagnosis and treatment of 66 cases of pediatric purulent meningitis.

Objective    To investigate the present situation of  pediatric purulent meningitis，including risk factors， clinical manifastation， diagnosis， treatment，and prognosis in order to provide information for definitive diagnosis and better treatment. Methods    All the clinical and laboratory data of 66 cases of pediatric purulent meningitis， who were admitted to Neurology Department of Children’s Hospital of Fudan University from January 2008 to April 2010，were collected， analysed， compared and summarized. The average age of all the patients was 6 months （from 30 days to 11 years），including 47 infants（71.2%），11 toddlers（16.7%），5 pre-school children （7.6%） and 3 school age cases （4.5%）. Results    Most cases in pre-school and school age had risk factors. According to the levels of our diagnosis，33.3% got definite pathogen diagnosis，50.0% got clinical diagnosis， and 16.7% got suspicious diagnosis. The positive rate of initial CSF（cerebral spinal fluid）was 62.5%，much higher than that of CSF in patients treated with antibiotics （29.8%）. The rate of abnormal high count of WBC in two different kinds of CSF had significant difference （P = 0.03），while there were no difference in the levels of glucose and protein of CSF. In the 66 cases，80.3% got well or improved，while 19.7% gave up. The course of treatment averaged 21days（5 to 56days），which had no difference between cases with 3 diagnosis levels. Some cases had complications，including subdural effusion， dysaudia，hydrocephalus and subdural empyema. Conclusion    Purulent meningitis continues to be an severe and emergent disease in neonates and children.Diagnosis with different standards according to clinical manifestation helps the management of pediatric purulent meningitis cases.