发热新生儿脑脊液结果异常的相关因素研究

发布时间：2018-05-20 07:25

本文选题：新生儿 + 脑脊液　；参考：《新乡医学院》2016年硕士论文

【摘要】：背景新生儿神经系统发育尚未成熟,血脑屏障发育不完善,其抵抗力及代偿能力差,易发生颅内感染。目前,对于新生儿颅内感染,国内尚无统一的诊断标准。颅内感染可引起患儿脑膜及脑实质广泛的炎性病变,导致脑细胞水肿、颅内高压、脑膜刺激征,甚至脑疝形成,使患儿遗留各种神经系统后遗症,比如智力倒退、肢体瘫痪、继发性癫痫等。因此,早期发现发热新生儿有无颅内感染并对其进行治疗至关重要,而脑脊液检查是确诊颅内感染的重要依据。腰椎穿刺术(腰穿)是一种有创性检查,存在一定风险:例如神经及软组织损伤、低颅压综合征、继发感染、颅内压升高等,严重时可引起脑疝、昏迷,甚至呼吸心跳停止以及无法预料的其他意外。发热新生儿易合并颅内感染,其临床表现可不具特异性,所以,应早诊断、早治疗,临床往往又需行腰椎穿刺术检查。目前,关于脑脊液结果异常与哪些临床因素相关,这些因素与行腰椎穿刺检查的必要性研究相对较少。目的研究发热新生儿的临床特点,比较分析发热新生儿行腰穿检查脑脊液结果正常者与脑脊液结果异常者之间的临床特点,以及有关实验室检查结果的差别,从而探讨发热新生儿脑脊液结果异常的相关危险因素,以指导临床对发热新生儿合理进行腰椎穿刺检查。方法采用回顾性队列分析研究方法,选择2014年3月—2015年10月在我院新生儿科住院的527例发热新生儿患者作为研究对象,将发热新生儿按照腰椎穿刺术脑脊液检查结果是否正常分为脑脊液结果正常组(对照组)与脑脊液结果异常组(观察组),研究发热新生儿的临床特征。将患儿发热最高体温、持续时间、发热时日龄、腰穿前外周血最高白细胞计数及超敏C反应蛋白数值、腰穿前抗生素应用时间、血培养、病原体感染、有无神经系统表现等并发症、有无合并先天基础病、胎龄、分娩方式、有无胎膜早破、阿氏评分、出生体重等临床资料进行分析,采用单因素分析两组间的差别。采用Logistic回归分析方法进行研究,根据统计学分析结果,分析发热新生儿脑脊液结果异常的相关危险因素。P0.05表示差异有统计学意义。结果本组527例行腰椎穿刺术检查的发热新生儿,其中有126例为脑脊液结果异常者,所占比例为23.91%。采用Logistic回归分析得知,以下因素为发热新生儿脑脊液结果异常的独立危险因素:最高体温38.5℃(OR:2.651,95%CI:1.672-4.099)、发热时日龄≤9d(OR:0.672,95%CI:0.654-1.004)、发热持续时间3d(OR:1.052,95%CI:1.047-1.242)、细菌感染(OR:2.779,95%CI:1.627-4.882)、病毒感染(OR:8.671,95%CI:1.672-4.099)、非典型菌感染(OR:1.561,95%CI:5.638-17.062)、腰穿前使用抗生素天数≤2d(OR:2.645,95%CI:1.472-3.038)、胎膜早破(OR:1.240,95%CI:1.156-2.219)。结论对于发热的新生儿来说,发热持续时间3d、发热时日龄≤9d、体温38.5℃、腰穿前使用抗生素≤2d、胎膜早破、病毒感染、细菌感染、非典型菌感染为发热新生儿脑脊液结果异常的独立危险因素;对于存在这些因素的发热新生儿,行腰椎穿刺术是有必要的,且对颅内感染的早期诊断及治疗大有益处。
[Abstract]:Background the development of neonatal nervous system is not mature, the development of blood brain barrier is not perfect, its resistance and compensatory ability are poor, and intracranial infection is easy to occur. At present, there is no unified diagnostic standard for intracranial infection in the newborn. Intracranial infection can cause extensive inflammatory lesions in the meninges and brain parenchyma, leading to brain cell edema and intracranial hypertension. Meningeal irritation and even the formation of brain hernia causes children to leave a variety of neurological sequelae, such as mental retrogression, paralysis of the limbs, secondary epilepsy and so on. Therefore, it is essential to find early neonatal infection without intracranial infection and to be treated for it, and the cerebrospinal fluid examination is an important basis for diagnosis of intracranial infection. There are some risks, such as nerve and soft tissue injury, low intracranial pressure syndrome, secondary infection, and high intracranial pressure, which can cause brain hernia, coma, even respiratory heartbeat and other unexpected accidents. Fever newborns are easy to combine with cranial infection, and their clinical manifestations are not specific, so early diagnosis should be taken. Fracture, early treatment, and clinical examination of lumbar puncture are often required. At present, what clinical factors are related to the abnormal results of cerebrospinal fluid and the necessity of lumbar puncture examination. The clinical characteristics of the abnormal cerebrospinal fluid and the difference between the results of the laboratory examination and the related risk factors of abnormal results of the cerebrospinal fluid in the febrile newborns were discussed in order to guide the rational examination of the lumbar puncture in the newborn infants with fever. The method of retrospective cohort analysis was used to select 10 - 2015. 527 cases of newborn infants hospitalized in the new Department of Pediatrics in our hospital were used as the research object. The clinical characteristics of the newborn were studied by the normal group of cerebrospinal fluid (control group) and the abnormal group of cerebrospinal fluid (observation group) according to the results of the cerebrospinal fluid examination of the lumbar puncture. Continuous time, fever of the age, the highest white blood cell count and hypersensitivity C reaction protein in peripheral blood before lumbar puncture, the application time of antibiotics before lumbar puncture, blood culture, infection of pathogens, and no nervous system manifestations, including congenital basic diseases, gestational age, delivery mode, or without premature rupture of membranes, ABI score, birth weight, etc. A single factor analysis was used to analyze the differences between the two groups. The Logistic regression analysis was used to make a study. According to the results of statistical analysis, the related risk factors of abnormal results of cerebrospinal fluid in newborn infants.P0.05 were statistically significant. Results in this group, 527 cases of fever neonates were examined by lumbar puncture, of which there were 126 cases. In the case of abnormal cerebrospinal fluid (CSF) results, the proportion of 23.91%. was analyzed by Logistic regression analysis. The following factors were independent risk factors of abnormal results in the cerebrospinal fluid of febrile newborns: the maximum body temperature was 38.5 (OR:2.651,95%CI:1.672-4.099), the age of fever was less than 9D (OR:0.672,95%CI: 0.654-1.004), and the duration of fever was 3D (OR:1.052,95%CI:1.047-1.24). 2) bacterial infection (OR:2.779,95%CI:1.627-4.882), virus infection (OR:8.671,95%CI:1.672-4.099), atypical bacterial infection (OR:1.561,95%CI:5.638-17.062), the number of antibiotics used before lumbar puncture is less than 2D (OR:2.645,95%CI:1.472-3.038), and premature rupture of membranes (OR:1.240,95%CI: 1.156-2.219). Conclusion for febrile newborns, fever duration 3D, hair The temperature is less than 9D, the temperature is 38.5, the antibiotics are less than 2D before the lumbar puncture, the premature rupture of the membranes, the virus infection, the bacterial infection, the atypical infection are the independent risk factors for the abnormal results of the cerebrospinal fluid in the newborn infants; the lumbar puncture is necessary for the newborn infants with these factors and the early diagnosis and treatment of the intracranial infection. It is of great benefit.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R722.1

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