中国全科医学2018，Vol.21Issue(7)：822-826,5.DOI:10.3969/j.issn.1007-9572.2018.07.014
儿童难治性化脓性脑膜炎的影响因素研究
Infuencing Factors of Refractory Purulent Meningitis in Children
摘要
Abstract
Objective To discuss the risk factors of refractory purulent meningitis (RPM) in children. Methods We enrolled 80 children with purulent meningitis (PM) treated in Inpatient Department, The Third Affiliated Hospital of Zhengzhou University from January 2014 to June 2017, including 30 with RPM (RPM group) and 50 with common purulent meningitis (CPM group). Comparisons were made between the groups in sex, age, body weight, minzu, season of onset, prevalence of prodromic infection, initial clinical manifestations, duration between the onset of PM and diagnosis, duration between the onset of PM and returning to the normal temperature, prevalence of repeated changes in temperature, prevalence of abnormal brain imaging results, results of blood culture, routine blood test [WBC, percentage of neutrophils, percentage of lymphocytes], C-reactive protein (CRP), cerebrospinal fluid (CSF) analysis [routine test (qualitative analysis of proteins, total number of cells, monocyte ratio, and ratio of binuclear cells), biochemical test[adenosine deaminase (ADA), glucose (GLU), lactate dehydrogenase (LDH), chloride (CL), protein quantitation] and CSF culture]. Multivariate stepwise Logistic regression analysis was conducted to explore the high-risk factors of RPM. Results The distribution of onset of season and qualitative analysis results of proteins differed significantly between the groups (P<0. 05), but the distribution of sex and minzu, mean age, mean body weight, prevalence of prodromic infection, prevalence of initial clinical manifestations such as fever, poor spirits / drowsiness, headache / vomiting and convulsions, duration between the onset of PM and diagnosis, blood culture results, percentage of neutrophils, percentage of lymphocytes, ratios of monocytes and binuclear cells in CSF did not (P>0. 05). Furthermore, compared with CPM group, RPM group demonstrated higher proportion of patients with initial clinical manifestations of irritability, refusing to suck and bulging anterior fontanelle, longer duration between the onset of PM and returning to the normal temperature, repeated changes in temperature, abnormal brain imaging results, higher WBC and CRP levels, GLU and CL levels in CSF, but lower total number of cells in CSF, ADA, LDH and protein quantitation levels in CSF and abnormal CSF culture results (P<0. 05). Multivariate stepwise logistic regression analysis exhibited that Initial clinical manfestations of bulging anterior fontanelle duration between the onset of PM and returning to the normal temperature, CRP level, total number of cells and ADA in CSF were associated factors for RPM in children (P<0.05). Conclusion Initial clinical manfestations of bulging anterior fontanelle. Increased duration between the onset of PM and returning to the normal temperature, elevated CRP level, and ADA in CSF were high-risk factors for RPM in children.关键词
脑膜炎/儿童/影响因素分析Key words
Meningitis/Children/Root cuuse analysis分类
医药卫生引用本文复制引用
杜开先,霍爱香,贾天明,禚志红,关静,高丽佳,李曼曼,张华玲..儿童难治性化脓性脑膜炎的影响因素研究[J].中国全科医学,2018,21(7):822-826,5.基金项目
河南省教育厅科学技术研究重点项目(13A320662) （13A320662）
