新生儿化脓性脑膜炎神经系统并发症的影响因素分析

目的　探讨分析新生儿化脓性脑膜炎神经系统并发症的影响因素。方法　选取2012年1月至2022年6月怀集县人民医院收治的92例新生儿化脓性脑膜炎，其中男51例、女41例，胎龄<37周25例、≥37周67例。根据头颅CT/MRI检查是否存在神经系统并发症（硬膜下积液、脑积水、脑脓肿、脑室管膜炎等），将患儿分为合并神经系统并发症组（22例）和无神经系统并发症组（70例）。收集患儿性别、出生体质量、发病日龄、发病至就诊时间，发热、热峰≥39 ℃、拒奶、嗜睡、黄疸、气促、反应差、前囟隆起、抽搐/惊厥、烦躁等体征，并检测其血清白细胞计数、中性粒细胞百分比、C反应蛋白（CRP）、血红蛋白、降钙素原和脑脊液白细胞计数、脑脊液蛋白质浓度、脑脊液糖浓度。进行单因素分析（χ²检验、独立样本t检验）、多因素logistic回归分析。结果　单因素分析结果显示，合并神经系统并发症组患儿胎龄低于无神经系统并发症组，前囟隆起、抽搐/惊厥、烦躁体征及血培养结果阳性、脑脊液培养结果阳性比例高于无神经系统并发症组，脑脊液白细胞计数、脑脊液蛋白质浓度、脑脊液糖浓度高于无神经系统并发症组（均P<0.05）。多因素logistic回归分析结果显示，胎龄（OR=4.166，95%CI：1.769～9.811）、抽搐/惊厥（OR=2.815，95%CI：1.443～5.492）、烦躁（OR=2.186，95%CI：1.350～3.540）、脑脊液白细胞计数过高（OR=3.348，95%CI：1.755～6.375）、脑脊液蛋白质浓度过高（OR=3.487，95%CI：1.833～6.632）是新生儿化脓性脑膜炎神经系统并发症的独立危险因素（均P<0.05）。结论　胎龄较低，脑脊液白细胞计数和蛋白质浓度过高，合并抽搐/惊厥、烦躁体征是新生儿化脓性脑膜炎神经系统并发症的重要影响因素。

Analysis of influence factors of nervous system complications in neonatal purulent meningitis

Objective　To analyze the influence factors of nervous system complications in neonatal purulent meningitis. Methods　A total of 92 cases of neonatal purulent meningitis admitted to Huaiji People's Hospital from January 2012 to June 2022 were selected, including 51 males and 41 females, 25 cases with gestational age <37 weeks and 67 cases with gestational age ≥37 weeks. According to the presence of nervous system complications (subdural effusion, hydrocephalus, brain abscess, ependymitis, etc.) examined by head CT/MRI, the children were divided into a nervous system complication group (22 cases) and a non-nervous system complication group (70 cases). The gender, birth weight, age of onset, time from onset to medical visit, and fever, heat peak ≥39 ℃, refusal to milk, lethargy, jaundice, shortness of breath, poor response, anterior fontanelle bulge, convulsions, irritability, and other signs were collected, and the serum white blood cell count, neutrophil percentage, C-reactive protein (CRP), hemoglobin, and procalcitonin levels and cerebrospinal fluid (CSF) white blood cell count, protein concentration, and glucose concentration were also measured. Univariate analysis (χ² test and independent sample t test) and multivariate logistic regression analysis were performed. Results　The results of univariate analysis showed that the gestational age in the nervous system complication group was lower than that in the non-nervous system complication group, the proportions of anterior fontanelle bulge, convulsions, irritability, positive blood culture, and positive CSF culture were higher than those in the non-nervous system complication group, and the CSF white blood cell count, protein concentration, and glucose concentration were higher than those in the non-nervous system complication group (all P<0.05). Multivariate logistic regression analysis showed that gestational age (OR=4.166, 95%CI: 1.769-9.811), convulsions (OR=2.815, 95%CI: 1.443-5.492), irritability (OR=2.186, 95%CI: 1.350-3.540), high CSF white blood cell count (OR=3.348, 95%CI: 1.755-6.375), and high CSF protein concentration (OR=3.487, 95%CI: 1.833-6.632) were independent risk factors for nervous system complications in neonatal purulent meningitis (all P<0.05). Conclusion　Low gestational age, high white blood cell count and protein concentration in the CSF, and combined convulsions and irritability signs are important factors affecting nervous system complications in neonatal purulent meningitis.