婴儿化脓性脑膜炎并发硬膜下积液的早期诊断

Early diagnosis of purulent meningitis complicated with subdural effusion

摘要:

目的：分析婴儿化脓性脑膜炎并发硬膜下积液的临床特征，寻找可能早期提示发生硬膜下积液的指标。方法：收集2002年1月至2013年9月于本院诊断为化脓性脑膜炎并发硬脑膜下积液的婴儿共129例，随机选择同期住院的129例无硬膜下积液化脑婴儿临床资料作为对照，采用t检验/卡方检验/秩和检验及logistic回归分析其临床特征。结果：婴儿化脓性脑膜炎并发硬膜下积液最常见的临床表现为发热、惊厥、呕吐、前囟膨隆。单因素分析提示：院外有发热、入院时前囟张力增高、瞳孔对光反射迟钝、意识障碍，入院后首次脑脊液蛋白、糖的水平以及脑脊液白细胞计数在２组间差异有统计学意义。多元logistic回归分析提示：入院时前囟张力增高、入院后首次脑脊液糖<1.5 mmol/L、脑脊液白细胞计数>200×106个/L可能作为提示婴儿化脑并发硬膜下积液的指标。结论：婴儿化脓性脑膜炎并发硬膜下积液并无特异性临床表现，临床转归与辅助检查相结合是确诊的保证，而对入院时前囟张力增高、入院后首次脑脊液糖<1.5 mmol/L、脑脊液白细胞>200×106个/L的婴儿，应警惕化脑并发硬膜下积液。

Abstract:

Objective：To analyze the clinical features of children with purulent meningitis（PM） complicated with subdural effusion（SE），and to search for the indicators of the early diagnosis for PM complicated with SE. Methods：A retrospective study was conducted among 258 children（129 children were diagnosed as PM complicated with SE，while the other randomly selected 129 children were diagnosed as PM only）. T test/Chi-square test/rank sum test and logistic regression analysis were used to explore the clinical features. Results：The most common clinical features were：fever，convulsion，vomiting，and bulging fontanelle，etc. The incidences of subdural effusions were closely correlated with the bulging font-anelle on admission，cerebrospinal fluid（CSF） glucose concentration on admission，and CSF white blood cell（WBC） counts on admission. Conclusion：There is no specific clinical manifestation in SE；clinical outcomes and auxiliary examinations can guarantee the right diagnosis. Those infants who have bulging anterior fontanelle on admission，CSF glucose concentration lower than 1.5 mmol/L，and CSF WBC count over than 200×106/L may develop SE.