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目的分析新生儿细菌性脑膜炎的临床表现、病原学特征及治疗方法 ,为早期诊断及治疗提供临床依据。方法对本院新生儿科2005年12月-2010年7月收治的45例新生儿细菌性脑膜炎的临床资料进行回顾性分析。根据发病日龄分为≤7 d组(15例)和>7 d组(30例),分析2组一般情况、临床表现、实验室检查及治疗方法等。结果临床表现以发热(86.7%)、抽搐(66.7%)、激惹(35.6%)为主,>7 d组肌张力升高、脑膜刺激征阳性多见。脑脊液培养阳性11例(24.4%)、涂片阳性3例(6.7%)、血培养阳性18例(40.0%),其中,凝固酶阴性葡萄球菌12例,G-杆菌11例。脑脊液蛋白水平与白细胞计数在脑脊液培养阳性、涂片阳性或查见脓细胞(18例)患儿与未见明确病原学特征(27例)患儿比较,差异无统计学意义。选用β-内酰胺类联合第三或第四代头孢菌素治疗,培养有阳性细菌生长后,再根据药敏试验及临床疗效选用敏感抗生素。治愈33例(73.3%),无效1例(2.2%),放弃治疗11例(24.5%),包括症状缓解5例和未愈6例。结论新生儿细菌性脑膜炎临床表现不典型,神经系统体征在发病日龄>7 d时表现相对明显;凝固酶阴性葡萄球菌为最常见的致病菌;治疗以β-内酰胺类联合第三代或第四代头孢菌素为主。
Objective To analyze the clinical manifestations, etiological characteristics and treatment of bacterial meningitis in newborns and provide a clinical basis for early diagnosis and treatment. Methods The clinical data of 45 neonates with bacterial meningitis admitted to our neonatology department from December 2005 to July 2010 were analyzed retrospectively. According to the age of onset were divided into ≤ 7 d group (15 cases) and> 7 d group (30 cases), two groups of general conditions, clinical manifestations, laboratory tests and treatment methods. Results The main clinical manifestations were fever (86.7%), convulsion (66.7%) and irritation (35.6%). Muscle tension increased more than 7 days and meningeal irritation was more common. Cerebrospinal fluid culture positive in 11 cases (24.4%), smear positive in 3 cases (6.7%), blood culture positive in 18 cases (40.0%), of which coagulase-negative staphylococci in 12 cases, G-bacteria in 11 cases. Cerebrospinal fluid protein levels and white blood cell count in cerebrospinal fluid culture was positive, smear positive or check see pus (18 cases) children with no clear pathogenic features (27 cases) children, the difference was not statistically significant. Select β-lactams combined third or fourth generation cephalosporins treatment, culture of positive bacteria growth, and then based on drug susceptibility testing and clinical efficacy of sensitive antibiotics. 33 cases were cured (73.3%), 1 case (2.2%) was ineffective and 11 cases (24.5%) were abrogated from treatment, including 5 cases of symptom relief and 6 cases of unhealed cure. Conclusions The clinical manifestations of bacterial meningitis in newborns are not typical. The signs of nervous system are relatively obvious at the onset day> 7 days. Coagulase-negative staphylococci are the most common pathogens. The treatment with β-lactams combined with the third Generation or fourth-generation cephalosporin-based.