某儿童医院儿童细菌性脑膜炎预后不良危险因素分析
发布时间：2018-11-23 11:55
【摘要】：目的通过回顾性分析160例细菌性脑膜炎住院患儿的病例资料,描述细菌性脑膜炎的临床特征,并探讨细菌性脑膜炎预后不良的危险因素。方法选择2009年02月01日至2013年12月31日我院收治符合化脓性脑膜炎诊断标准的160例患儿为研究对象。根据患儿预后将其分为分为A、B两组。A组91例为预后良好组;B组69例为预后不良组。所有患儿均常规采集病史,进行体格检查,行腰椎腰椎穿刺术进行脑脊液检查(取首次入院时的脑脊液检查结果进行分析)。分别检测各患儿血CRP反应蛋白,血生化,血培养,淋巴细胞亚群+CD64,降钙素原,以及血、尿、粪常规。自制《化脓性脑膜炎患儿基本信息采集表》,收集符合纳入条件的患儿入院时基本信息、出生时情况、既往史、家庭史、临床症状及体征、体格检查、并发症、临床转归、实验室和辅助检查结果等相关资料。采用SPSS 11.5统计软件进行统计分析,首先通过单因素分析筛选出影响化脑不良预后的变量,再进行logistic逐步回归分析患儿预后不良的危险因素。结果本研究中160例细菌性膜炎患儿发病年龄主要在0至3岁之间,农村和城郊患儿比例高于城市。单因素分析结果显示B组的平均发病年龄、家庭月收入低于A组,而农村和城郊患儿所占比例高于A组,差异均有统计学意义(P0.05)。两组间病史资料比较显示B组中耳炎罹患率高于A组,差异有统计学意义(P0.05)。两组间比较显示,起病至开始治疗时间大于3天的比例B组显著性高于A组(P0.05),B组患儿发生意识障碍、抽搐、硬膜下积液、脑积水、脑室管膜炎、脑梗塞、脑脓肿、休克的比例高于A组,差异有统计学意义(P0.05)。脑脊液有核细胞计数、脑脊液氯化物含量、CD64、CRP、降钙素原、血/脑脊液培养阳性在两组间差异无统计学意义(P0.05)。脑脊液蛋白含量B组高于A组(P0.05),但糖含量B组明显低于A组(P0.05)。发热、呕吐和脑膜刺激征阳性、脑电图异常在两组间比较差异无统计学意义(P0.05)。Logistic逐步回归分析结果表明,脑脊液蛋白含量越高、糖含量越低、意识障碍越明显、脑梗塞、起病至开始治疗时间大于3天等5项变量是影响化脓性脑膜炎预后的危险因素。结论细菌性脑炎预后受多种因素影响,脑脊液蛋白含量高、糖含量低、意识障碍明显、并发脑梗塞、延误治疗可增加预后不良的发生风险。因此,对于有上述高危因素的患儿应及时进行干预,尽可能防范后遗症的发生,从而提高患儿的生活质量。
[Abstract]:Objective to analyze the clinical features of bacterial meningitis and explore the risk factors of poor prognosis of bacterial meningitis by retrospectively analyzing the data of 160 hospitalized children with bacterial meningitis. Methods 160 children with suppurative meningitis who were admitted to our hospital from February 01, 2009 to December 31, 2013 were selected. According to the prognosis of the children, they were divided into two groups: group A (91 cases) and group B (69 cases) with poor prognosis. All the children were routinely collected medical history, physical examination, lumbar puncture for cerebrospinal fluid examination (the results of the first admission cerebrospinal fluid examination were analyzed). Serum CRP reactive protein, blood biochemistry, blood culture, lymphocyte subgroup CD64, procalcitonin, blood, urine and fecal routine were detected. To collect the basic information of children with suppurative meningitis on admission, birth condition, past history, family history, clinical symptoms and signs, physical examination, complications, clinical outcome. Laboratory and auxiliary examination results and other relevant materials. SPSS 11.5 statistical software was used to analyze the risk factors of poor prognosis of children with logistic stepwise regression analysis. First, the variables affecting the poor prognosis of the brain were screened by univariate analysis. The risk factors of poor prognosis were analyzed by logistic stepwise regression analysis. Results the incidence age of 160 children with bacterial meningitis was between 0 and 3 years old, and the proportion of children in rural and suburban areas was higher than that in urban areas. Univariate analysis showed that the average age of onset and monthly income of families in group B were lower than those in group A, while the proportion of children in rural and suburban areas was higher than that in group A, the difference was statistically significant (P0.05). The incidence of otitis media in group B was higher than that in group A (P0.05). The comparison between the two groups showed that the proportion of patients in group B was significantly higher than that in group A (P0.05). The incidence of disturbance of consciousness, convulsions, subdural effusion, hydrocephalus, ependymitis, cerebral infarction, brain abscess were significantly higher in group B than in group A (P0.05). The proportion of shock in group A was higher than that in group A, the difference was statistically significant (P0.05). There were no significant differences between the two groups in the number of nucleated cells in cerebrospinal fluid, the content of chloride in CSF, CD64,CRP, procalcitonin and blood / cerebrospinal fluid culture (P0.05). The content of cerebrospinal fluid protein in group B was higher than that in group A (P0.05), but the content of sugar in group B was significantly lower than that in group A (P0.05). There was no significant difference in fever, vomiting, meningeal stimulation sign and EEG abnormality between the two groups (P0.05). Logistic stepwise regression analysis showed that the higher the content of cerebrospinal fluid protein, the lower the sugar content, the more obvious the disturbance of consciousness. Five variables, such as cerebral infarction, from onset to beginning of treatment, were risk factors for prognosis of suppurative meningitis. Conclusion the prognosis of bacterial encephalitis is affected by many factors. The cerebrospinal fluid has high protein content, low sugar content, obvious disturbance of consciousness, complicated with cerebral infarction and delayed treatment can increase the risk of poor prognosis. Therefore, children with these high risk factors should intervene in time to prevent sequelae as far as possible and improve their quality of life.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.1
本文编号：2351519
[Abstract]:Objective to analyze the clinical features of bacterial meningitis and explore the risk factors of poor prognosis of bacterial meningitis by retrospectively analyzing the data of 160 hospitalized children with bacterial meningitis. Methods 160 children with suppurative meningitis who were admitted to our hospital from February 01, 2009 to December 31, 2013 were selected. According to the prognosis of the children, they were divided into two groups: group A (91 cases) and group B (69 cases) with poor prognosis. All the children were routinely collected medical history, physical examination, lumbar puncture for cerebrospinal fluid examination (the results of the first admission cerebrospinal fluid examination were analyzed). Serum CRP reactive protein, blood biochemistry, blood culture, lymphocyte subgroup CD64, procalcitonin, blood, urine and fecal routine were detected. To collect the basic information of children with suppurative meningitis on admission, birth condition, past history, family history, clinical symptoms and signs, physical examination, complications, clinical outcome. Laboratory and auxiliary examination results and other relevant materials. SPSS 11.5 statistical software was used to analyze the risk factors of poor prognosis of children with logistic stepwise regression analysis. First, the variables affecting the poor prognosis of the brain were screened by univariate analysis. The risk factors of poor prognosis were analyzed by logistic stepwise regression analysis. Results the incidence age of 160 children with bacterial meningitis was between 0 and 3 years old, and the proportion of children in rural and suburban areas was higher than that in urban areas. Univariate analysis showed that the average age of onset and monthly income of families in group B were lower than those in group A, while the proportion of children in rural and suburban areas was higher than that in group A, the difference was statistically significant (P0.05). The incidence of otitis media in group B was higher than that in group A (P0.05). The comparison between the two groups showed that the proportion of patients in group B was significantly higher than that in group A (P0.05). The incidence of disturbance of consciousness, convulsions, subdural effusion, hydrocephalus, ependymitis, cerebral infarction, brain abscess were significantly higher in group B than in group A (P0.05). The proportion of shock in group A was higher than that in group A, the difference was statistically significant (P0.05). There were no significant differences between the two groups in the number of nucleated cells in cerebrospinal fluid, the content of chloride in CSF, CD64,CRP, procalcitonin and blood / cerebrospinal fluid culture (P0.05). The content of cerebrospinal fluid protein in group B was higher than that in group A (P0.05), but the content of sugar in group B was significantly lower than that in group A (P0.05). There was no significant difference in fever, vomiting, meningeal stimulation sign and EEG abnormality between the two groups (P0.05). Logistic stepwise regression analysis showed that the higher the content of cerebrospinal fluid protein, the lower the sugar content, the more obvious the disturbance of consciousness. Five variables, such as cerebral infarction, from onset to beginning of treatment, were risk factors for prognosis of suppurative meningitis. Conclusion the prognosis of bacterial encephalitis is affected by many factors. The cerebrospinal fluid has high protein content, low sugar content, obvious disturbance of consciousness, complicated with cerebral infarction and delayed treatment can increase the risk of poor prognosis. Therefore, children with these high risk factors should intervene in time to prevent sequelae as far as possible and improve their quality of life.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.1
【参考文献】
相关期刊论文 前2条
1 李建宁;黎雪英;庞祥华;曹龙翎;;降钙素原对新生儿感染性疾病诊断意义的探讨[J];吉林医学;2012年17期
2 刘敏;庞玉生;石靖;;细菌性脑膜炎并脑积水的临床特点及危险因素[J];实用儿科临床杂志;2012年10期
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