本文關(guān)鍵詞： 兒童 化膿性腦膜炎 致病菌 臨床特點(diǎn) 預(yù)后　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:分析并總結(jié)兒童化膿性腦膜炎(Purulent Meningitis,PM)的臨床特點(diǎn)及近期預(yù)后的相關(guān)因素,為該病的早期診斷與合理治療提供一定的參考。方法:選取2013年09月至2016年09月山西省兒童醫(yī)院收治的94例PM患兒,回顧性分析其臨床資料,歸納總結(jié)兒童PM的臨床特點(diǎn);根據(jù)Glasgow臨床結(jié)局評(píng)分的結(jié)果將患兒分為預(yù)后良好組(5分)和預(yù)后不良組(1~4分),對(duì)比分析并篩選出具有統(tǒng)計(jì)學(xué)差異的預(yù)后相關(guān)因素(P0.05);對(duì)具有統(tǒng)計(jì)學(xué)差異的單因素進(jìn)一步做多元Logistic回歸分析,尋找導(dǎo)致兒童PM近期預(yù)后不良的獨(dú)立危險(xiǎn)因素。結(jié)果:1、納入研究的患兒共計(jì)94例,其中男性63例,女性31例,男女比例為2.03:1;嬰幼兒(80.86%)為高發(fā)人群;且患兒主要來自于農(nóng)村(62.77%);全年均有發(fā)病,以秋季為主。2、兒童PM主要臨床表現(xiàn)有發(fā)熱(90.43%),精神/反應(yīng)差(73.40%),驚厥(50.00%),頭痛/頭暈/嘔吐(47.87%),腦膜刺激征陽性(39.36%),病理征陽性(31.91%),意識(shí)障礙(29.79%),前囟膨隆(25.53%)等;年齡較大的兒童多出現(xiàn)頭痛/頭暈/嘔吐、腦膜刺激征;嬰兒多表現(xiàn)為精神/反應(yīng)差、前囟膨隆;主要致病菌分別為肺炎鏈球菌(35.11%),腸球菌(18.09%),凝固酶陰性葡萄球菌(13.83%),大腸埃希菌(11.7%)。3、預(yù)后良好組占60.64%,預(yù)后不良組占39.36%;經(jīng)單因素分析得出CRP、CSF-LDH、CSF-LA、CSF-Glu1.5mmol/L、CSF-Pro1.0g、驚厥、入院后頻繁驚厥、意識(shí)障礙、急性期并發(fā)癥、使用丙球、致病菌為肺炎鏈球菌等共11項(xiàng)指標(biāo)均與預(yù)后不良有一定的相關(guān)性;經(jīng)多元Logistic回歸模型進(jìn)行分析,篩選出3項(xiàng)影響PM患兒近期預(yù)后的獨(dú)立危險(xiǎn)因素:CSF-LDH、入院后頻繁驚厥和意識(shí)障礙。結(jié)論:兒童PM以男性為主,嬰幼兒多發(fā),主要致病菌分別為肺炎鏈球菌,腸球菌,凝固酶陰性葡萄球菌,大腸埃希菌。CSF-LDH水平升高、入院后頻繁驚厥和意識(shí)障礙是兒童PM預(yù)后不良的獨(dú)立危險(xiǎn)因素。臨床中應(yīng)及時(shí)識(shí)別相關(guān)危險(xiǎn)因素,積極應(yīng)對(duì)、合理治療,減少預(yù)后不良情況的發(fā)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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R742.9

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