儿童化脓性脑膜炎的临床特点及近期预后的相关因素分析

发布时间：2018-02-26 05:10

本文关键词： 儿童化脓性脑膜炎致病菌临床特点预后　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析并总结儿童化脓性脑膜炎(Purulent Meningitis,PM)的临床特点及近期预后的相关因素,为该病的早期诊断与合理治疗提供一定的参考。方法:选取2013年09月至2016年09月山西省儿童医院收治的94例PM患儿,回顾性分析其临床资料,归纳总结儿童PM的临床特点;根据Glasgow临床结局评分的结果将患儿分为预后良好组(5分)和预后不良组(1~4分),对比分析并筛选出具有统计学差异的预后相关因素(P0.05);对具有统计学差异的单因素进一步做多元Logistic回归分析,寻找导致儿童PM近期预后不良的独立危险因素。结果:1、纳入研究的患儿共计94例,其中男性63例,女性31例,男女比例为2.03:1;婴幼儿(80.86%)为高发人群;且患儿主要来自于农村(62.77%);全年均有发病,以秋季为主。2、儿童PM主要临床表现有发热(90.43%),精神/反应差(73.40%),惊厥(50.00%),头痛/头晕/呕吐(47.87%),脑膜刺激征阳性(39.36%),病理征阳性(31.91%),意识障碍(29.79%),前囟膨隆(25.53%)等;年龄较大的儿童多出现头痛/头晕/呕吐、脑膜刺激征;婴儿多表现为精神/反应差、前囟膨隆;主要致病菌分别为肺炎链球菌(35.11%),肠球菌(18.09%),凝固酶阴性葡萄球菌(13.83%),大肠埃希菌(11.7%)。3、预后良好组占60.64%,预后不良组占39.36%;经单因素分析得出CRP、CSF-LDH、CSF-LA、CSF-Glu1.5mmol/L、CSF-Pro1.0g、惊厥、入院后频繁惊厥、意识障碍、急性期并发症、使用丙球、致病菌为肺炎链球菌等共11项指标均与预后不良有一定的相关性;经多元Logistic回归模型进行分析,筛选出3项影响PM患儿近期预后的独立危险因素:CSF-LDH、入院后频繁惊厥和意识障碍。结论:儿童PM以男性为主,婴幼儿多发,主要致病菌分别为肺炎链球菌,肠球菌,凝固酶阴性葡萄球菌,大肠埃希菌。CSF-LDH水平升高、入院后频繁惊厥和意识障碍是儿童PM预后不良的独立危险因素。临床中应及时识别相关危险因素,积极应对、合理治疗,减少预后不良情况的发生。
[Abstract]:Objective: to analyze and summarize the clinical characteristics of children with purulent meningitis PurulentMeningitis (PMN) and the related factors of short-term prognosis. Methods: 94 children with PM were selected from September 2013 to September 2016 in Shanxi Children's Hospital. The clinical data were analyzed retrospectively and the clinical characteristics of children PM were summarized. According to the clinical outcome score of Glasgow, the children were divided into good prognosis group (5 points) and poor prognosis group (1 ~ 4 points). Multivariate Logistic regression analysis was done in one step. Results among 94 children in the study, 63 were male, 31 were female, the ratio of male to female was 2.03: 1, and the infant was 80.86). And the children mainly come from the rural area 62.77m, and they have the disease all year round. The main clinical manifestations of children PM in autumn were fever 90.43m, psychosis / bad reaction 73.40m, convulsion 50.005, headache / dizziness / vomiting 47.87m, meningeal stimulation positive 39.36D, pathological sign 31.91C, consciousness disturbance 29.7979, anterior fontanelle bulging 25.53). In older children, headache / dizziness / vomiting, meningeal irritation were more common in children, and infants showed mental / poor response, anterior fontanelle bulging. The main pathogenic bacteria were Streptococcus pneumoniae 35.11, Enterococcus 18.09, coagulase negative Staphylococcus 13.833, Escherichia coli 11.770.3.The prognosis group accounted for 60.64 and the poor prognosis group 39.36.The single factor analysis showed that CRPCSF-LDF-LDCSF-LACSF-Glu-CSF-Glu1.5mmol-Glu-CSF-Pro1.0g, convulsion, frequent convulsion after admission, disturbance of consciousness, The acute complications, the use of C ball and the pathogenic bacteria of Streptococcus pneumoniae were all correlated with the poor prognosis, and were analyzed by multivariate Logistic regression model. Three independent risk factors affecting the prognosis of children with PM were screened out, including: 1. CSF-LDH, frequent convulsion and disturbance of consciousness after admission. Conclusion: children with PM are mainly male, and the main pathogens are Streptococcus pneumoniae and Enterococcus, respectively, the main pathogens are Streptococcus pneumoniae and Enterococcus. Coagulase-negative staphylococci, Escherichia coli. CSF-LDH, frequent convulsion after admission and disturbance of consciousness are independent risk factors for poor prognosis of children with PM. Reduce the incidence of poor prognosis.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.9

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