某兒童醫(yī)院兒童細(xì)菌性腦膜炎預(yù)后不良危險因素分析
發(fā)布時間：2018-11-23 11:55
【摘要】：目的通過回顧性分析160例細(xì)菌性腦膜炎住院患兒的病例資料,描述細(xì)菌性腦膜炎的臨床特征,并探討細(xì)菌性腦膜炎預(yù)后不良的危險因素。方法選擇2009年02月01日至2013年12月31日我院收治符合化膿性腦膜炎診斷標(biāo)準(zhǔn)的160例患兒為研究對象。根據(jù)患兒預(yù)后將其分為分為A、B兩組。A組91例為預(yù)后良好組;B組69例為預(yù)后不良組。所有患兒均常規(guī)采集病史,進(jìn)行體格檢查,行腰椎腰椎穿刺術(shù)進(jìn)行腦脊液檢查(取首次入院時的腦脊液檢查結(jié)果進(jìn)行分析)。分別檢測各患兒血CRP反應(yīng)蛋白,血生化,血培養(yǎng),淋巴細(xì)胞亞群+CD64,降鈣素原,以及血、尿、糞常規(guī)。自制《化膿性腦膜炎患兒基本信息采集表》,收集符合納入條件的患兒入院時基本信息、出生時情況、既往史、家庭史、臨床癥狀及體征、體格檢查、并發(fā)癥、臨床轉(zhuǎn)歸、實驗室和輔助檢查結(jié)果等相關(guān)資料。采用SPSS 11.5統(tǒng)計軟件進(jìn)行統(tǒng)計分析,首先通過單因素分析篩選出影響化腦不良預(yù)后的變量,再進(jìn)行l(wèi)ogistic逐步回歸分析患兒預(yù)后不良的危險因素。結(jié)果本研究中160例細(xì)菌性膜炎患兒發(fā)病年齡主要在0至3歲之間,農(nóng)村和城郊患兒比例高于城市。單因素分析結(jié)果顯示B組的平均發(fā)病年齡、家庭月收入低于A組,而農(nóng)村和城郊患兒所占比例高于A組,差異均有統(tǒng)計學(xué)意義(P0.05)。兩組間病史資料比較顯示B組中耳炎罹患率高于A組,差異有統(tǒng)計學(xué)意義(P0.05)。兩組間比較顯示,起病至開始治療時間大于3天的比例B組顯著性高于A組(P0.05),B組患兒發(fā)生意識障礙、抽搐、硬膜下積液、腦積水、腦室管膜炎、腦梗塞、腦膿腫、休克的比例高于A組,差異有統(tǒng)計學(xué)意義(P0.05)。腦脊液有核細(xì)胞計數(shù)、腦脊液氯化物含量、CD64、CRP、降鈣素原、血/腦脊液培養(yǎng)陽性在兩組間差異無統(tǒng)計學(xué)意義(P0.05)。腦脊液蛋白含量B組高于A組(P0.05),但糖含量B組明顯低于A組(P0.05)。發(fā)熱、嘔吐和腦膜刺激征陽性、腦電圖異常在兩組間比較差異無統(tǒng)計學(xué)意義(P0.05)。Logistic逐步回歸分析結(jié)果表明,腦脊液蛋白含量越高、糖含量越低、意識障礙越明顯、腦梗塞、起病至開始治療時間大于3天等5項變量是影響化膿性腦膜炎預(yù)后的危險因素。結(jié)論細(xì)菌性腦炎預(yù)后受多種因素影響,腦脊液蛋白含量高、糖含量低、意識障礙明顯、并發(fā)腦梗塞、延誤治療可增加預(yù)后不良的發(fā)生風(fēng)險。因此,對于有上述高危因素的患兒應(yīng)及時進(jìn)行干預(yù),盡可能防范后遺癥的發(fā)生,從而提高患兒的生活質(zhì)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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R725.1
本文編號：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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R725.1
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相關(guān)期刊論文 前2條
1 李建寧;黎雪英;龐祥華;曹龍翎;;降鈣素原對新生兒感染性疾病診斷意義的探討[J];吉林醫(yī)學(xué);2012年17期
2 劉敏;龐玉生;石靖;;細(xì)菌性腦膜炎并腦積水的臨床特點(diǎn)及危險因素[J];實用兒科臨床雜志;2012年10期
，本文編號：2351519
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