【摘要】 目的 分析新生儿难治性化脓性脑膜炎的临床特点及危险因素。方法 回顾性分析2017年1月至12月昆明市儿童医院新生儿科收治的141例化脓性脑膜炎患儿的临床资料，根据细菌培养结果分为普通组（99例）与难治组（42例），比较两组患儿一般资料、临床表现及实验室检查结果，采用logistic回归分析新生儿难治性化脓性脑膜炎的危险因素。结果 两组男性患儿、早产儿、出生体重<2 500 g、羊水污染、早发型脑膜炎、入院前接受抗感染治疗占比比较，差异无统计学意义（P> 0.05）。两组患儿发热、抽搐、呼吸道症状、消化道症状占比比较，差异无统计学意义（P> 0.05）。难治组血降钙素原（PCT）升高、细菌培养阳性占比高于普通组，脑脊液（CSF）白细胞计数、CSF蛋白含量高于普通组，CSF葡萄糖含量低于普通组（P <0.05）；两组外周血白细胞计数异常、血C反应蛋白升高占比比较，差异无统计学意义（P> 0.05）。两组病原菌分布比较，差异无统计学意义（P> 0.05）。两组患儿神经系统症状总发生率比较，差异有统计学意义（P <0.05）。难治组患儿退热时间、住院时间长于普通组（P <0.05）；两组临床转归比较，差异无统计学意义（P> 0.05）。高CSF蛋白含量、合并神经系统症状是新生儿难治性化脓性脑膜炎的独立危险因素（OR> 1,P <0.05），高CSF葡萄糖含量是新生儿难治性化脓性脑膜炎的保护因素（OR <1,P <0.05）。结论 新生儿难治性化脓性脑膜炎临床表现不典型，患儿血、CSF感染标志物明显异常，神经系统症状突出，治疗较困难；血PCT、CSF蛋白含量增高及合并神经系统症状均为新生儿难治性化脓性脑膜炎的独立危险因素，高CSF葡萄糖含量是其保护因素。更多还原

【Abstract】 Objective To analyze the clinical characteristics and risk factors of neonatal refractory purulent meningitis.Methods The clinical data of 141 children with purulent meningitis who were admitted to the Department of Neonatology, Kunming Children’s Hospital from January to December 2017 were retrospectively analyzed. According to the bacterial culture results, they were divided into common group(99 cases) and refractory group(42 cases). General data, clinical manifestations, and laboratory test results of two groups were compared. The risk factors of refractory purulent meningitis in neonates were analyzed by logistic regression. Results There were no significant differences in the proportion of male infants, premature infant, birth weight < 2 500 g, amniotic fluid contamination, early-onset meningitis, and anti-infective treatment before admission between two groups(P > 0.05). There was no significant difference in the proportion of fever, convulsion, respiratory symptoms, and digestive tract symptoms between two groups(P > 0.05). The proportion of elevated blood plasma procalcitonin(PCT), positive bacteria culture was higher in refractory group than those in normal group, the white blood cell count and protein content of cerebrospinal fluid(CSF)were higher than those in normal group, and the glucose content of CSF was lower than that in normal group(P < 0.05);there was no significant difference in the proportion of abnormal peripheral blood white blood cell count and elevated blood C-reactive protein between two groups(P > 0.05). There was no significant difference in the distribution of pathogenic bacteria between two groups(P > 0.05). The total incidence of neurological symptoms between two groups was statistically significant(P < 0.05). The fever-reducing time and hospitalization time in refractory group were longer than those in normal group(P < 0.05); there was no significant difference in clinical outcome between two groups(P > 0.05). High CSF protein content, combined with neurological symptoms were independent risk factors for refractory neonatal purulent meningitis(OR > 1, P < 0.05), and high CSF glucose content was a protective factor for refractory neonatal purulent meningitis(OR < 1, P < 0.05). Conclusion The clinical manifestations of neonatal refractory purulent meningitis are not typical. The blood and CSF infection markers of the children are significantly abnormal, and neurological symptoms are prominent. Therefore, it is difficult to treat such children. High blood PCT and CSF protein content, and combined with neurological symptoms are independent risk factors for neonatal refractory purulent meningitis, and high CSF glucose content is a protective factor.更多还原