本文選題：新生兒 + 腦脊液��； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2016年碩士論文

【摘要】：背景新生兒神經(jīng)系統(tǒng)發(fā)育尚未成熟,血腦屏障發(fā)育不完善,其抵抗力及代償能力差,易發(fā)生顱內(nèi)感染。目前,對(duì)于新生兒顱內(nèi)感染,國(guó)內(nèi)尚無(wú)統(tǒng)一的診斷標(biāo)準(zhǔn)。顱內(nèi)感染可引起患兒腦膜及腦實(shí)質(zhì)廣泛的炎性病變,導(dǎo)致腦細(xì)胞水腫、顱內(nèi)高壓、腦膜刺激征,甚至腦疝形成,使患兒遺留各種神經(jīng)系統(tǒng)后遺癥,比如智力倒退、肢體癱瘓、繼發(fā)性癲癇等。因此,早期發(fā)現(xiàn)發(fā)熱新生兒有無(wú)顱內(nèi)感染并對(duì)其進(jìn)行治療至關(guān)重要,而腦脊液檢查是確診顱內(nèi)感染的重要依據(jù)。腰椎穿刺術(shù)(腰穿)是一種有創(chuàng)性檢查,存在一定風(fēng)險(xiǎn):例如神經(jīng)及軟組織損傷、低顱壓綜合征、繼發(fā)感染、顱內(nèi)壓升高等,嚴(yán)重時(shí)可引起腦疝、昏迷,甚至呼吸心跳停止以及無(wú)法預(yù)料的其他意外。發(fā)熱新生兒易合并顱內(nèi)感染,其臨床表現(xiàn)可不具特異性,所以,應(yīng)早診斷、早治療,臨床往往又需行腰椎穿刺術(shù)檢查。目前,關(guān)于腦脊液結(jié)果異常與哪些臨床因素相關(guān),這些因素與行腰椎穿刺檢查的必要性研究相對(duì)較少。目的研究發(fā)熱新生兒的臨床特點(diǎn),比較分析發(fā)熱新生兒行腰穿檢查腦脊液結(jié)果正常者與腦脊液結(jié)果異常者之間的臨床特點(diǎn),以及有關(guān)實(shí)驗(yàn)室檢查結(jié)果的差別,從而探討發(fā)熱新生兒腦脊液結(jié)果異常的相關(guān)危險(xiǎn)因素,以指導(dǎo)臨床對(duì)發(fā)熱新生兒合理進(jìn)行腰椎穿刺檢查。方法采用回顧性隊(duì)列分析研究方法,選擇2014年3月—2015年10月在我院新生兒科住院的527例發(fā)熱新生兒患者作為研究對(duì)象,將發(fā)熱新生兒按照腰椎穿刺術(shù)腦脊液檢查結(jié)果是否正常分為腦脊液結(jié)果正常組(對(duì)照組)與腦脊液結(jié)果異常組(觀察組),研究發(fā)熱新生兒的臨床特征。將患兒發(fā)熱最高體溫、持續(xù)時(shí)間、發(fā)熱時(shí)日齡、腰穿前外周血最高白細(xì)胞計(jì)數(shù)及超敏C反應(yīng)蛋白數(shù)值、腰穿前抗生素應(yīng)用時(shí)間、血培養(yǎng)、病原體感染、有無(wú)神經(jīng)系統(tǒng)表現(xiàn)等并發(fā)癥、有無(wú)合并先天基礎(chǔ)病、胎齡、分娩方式、有無(wú)胎膜早破、阿氏評(píng)分、出生體重等臨床資料進(jìn)行分析,采用單因素分析兩組間的差別。采用Logistic回歸分析方法進(jìn)行研究,根據(jù)統(tǒng)計(jì)學(xué)分析結(jié)果,分析發(fā)熱新生兒腦脊液結(jié)果異常的相關(guān)危險(xiǎn)因素。P0.05表示差異有統(tǒng)計(jì)學(xué)意義。結(jié)果本組527例行腰椎穿刺術(shù)檢查的發(fā)熱新生兒,其中有126例為腦脊液結(jié)果異常者,所占比例為23.91%。采用Logistic回歸分析得知,以下因素為發(fā)熱新生兒腦脊液結(jié)果異常的獨(dú)立危險(xiǎn)因素:最高體溫38.5℃(OR:2.651,95%CI:1.672-4.099)、發(fā)熱時(shí)日齡≤9d(OR:0.672,95%CI:0.654-1.004)、發(fā)熱持續(xù)時(shí)間3d(OR:1.052,95%CI:1.047-1.242)、細(xì)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數(shù)≤2d(OR:2.645,95%CI:1.472-3.038)、胎膜早破(OR:1.240,95%CI:1.156-2.219)。結(jié)論對(duì)于發(fā)熱的新生兒來(lái)說(shuō),發(fā)熱持續(xù)時(shí)間3d、發(fā)熱時(shí)日齡≤9d、體溫38.5℃、腰穿前使用抗生素≤2d、胎膜早破、病毒感染、細(xì)菌感染、非典型菌感染為發(fā)熱新生兒腦脊液結(jié)果異常的獨(dú)立危險(xiǎn)因素;對(duì)于存在這些因素的發(fā)熱新生兒,行腰椎穿刺術(shù)是有必要的,且對(duì)顱內(nèi)感染的早期診斷及治療大有益處。
[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.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R722.1

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