探讨新生儿化脓性脑膜炎的临床特点。

选取2011年1月1日至2016年12月31日，广西壮族自治区妇幼保健院新生儿科收治的90例新生儿化脓性脑膜炎患儿为研究对象。采用回顾性方法分析，收集90例新生儿化脓性脑膜炎患儿的临床表现、实验室检查结果、治疗及转归等临床资料。采用χ²检验，对受试儿血清C反应蛋白(CRP)异常率与白细胞计数异常率，以及脑脊液有核细胞数升高(≥20个/mm³)、蛋白含量升高(≥1.5 g/L)、葡萄糖含量降低(<1.8 mmol/L)患儿所占比例进行统计学比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

①90例受试儿中，最主要的临床表现为发热(70.0%，63/90)，其次为反应差(21.1%，19/90)和惊厥(18.9%，17/90)。②90例受试儿的血常规检查结果显示，血清CRP异常率为48.9%(44/90)，显著高于白细胞计数异常率(26.7%，24/90)，二者比较，差异有统计学意义(χ²＝9.454，P＝0.002)。③90例受试儿的脑脊液检查结果显示，脑脊液有核细胞数升高受试儿所占比例为86.7%(78/90)，显著高于脑脊液蛋白含量升高受试儿所占比例(40.0%，36/90)和葡萄糖含量降低受试儿所占比例(41.1%，37/90)，分别两两比较，差异均有统计学意义(χ²＝42.201、40.479，P<0.001)；而脑脊液蛋白含量升高患儿所占比例与葡萄糖含量降低患儿所占比例比较，差异无统计学意义(χ²＝0.023，P＝0.879)。④90例受试儿中，血培养结果呈阳性者为11例(12.2%)，脑脊液培养结果呈阳性者为1例(1.1%)。⑤受试儿MRI检查结果显示，合并硬膜下积液、脑室扩张和脑积水者各为1例。⑥90例受试儿经治疗后，67例(74.4%)治愈出院，23例(25.6%)好转出院。

新生儿化脓性脑膜炎患儿临床表现不典型，对于不明原因发热、反应差等具有高危因素新生儿，临床应尽早完善相关检查及尽早治疗，以改善该病患儿预后。

To investigate the clinical features of neonatal purulent meningitis.

A retrospective study was performed on 90 neonates with neonatal purulent meningitis who were admitted into Department of Neonatology, Guangxi Zhuang Autonomous Region Maternal and Child Health Care Hospital from January 1, 2011 to December 31, 2016. The clinical manifestations, laboratory results, treatments and outcomes were retrospectively analyzed. The chi-square test was used to statistically compare the abnormal rates of C reactive protein (CRP) and white blood cell count, and the proportions of elevated nucleated cells (≥20 cells/mm³), elevated protein content(≥1.5 g/L), and reduced glucose content (<1.8 mmol/L) in cerebrospinal fluid. This study was consistent with the requirements of World Medical Association Declaration of Helsinki revised in 2013.

①Among the 90 children, the most predominant clinical manifestation was fever (70.0%, 63/90), followed by poor response (21.1%, 19/90) and convulsions (18.9%, 17/90). ② The results of routine blood test of the 90 children showed that the abnormal rate of CRP was 48.9% (44/90), which was significantly higher than the abnormal rate of white blood cell count (26.7%, 24/90). There was a statistically significant difference between them (χ²=9.454, P=0.002). ③ Cerebrospinal fluid examination results of the 90 children showed that the proportion of elevated nucleated cells in cerebrospinal fluid was 86.7% (78/90), which was significantly higher than the proportion of elevated protein content (40.0%, 36/90) and reduced glucose content (41.1%, 37/90) in cerebrospinal fluid, respectively, and there were statistically significant differences between them (χ²=42.201, 40.479; P<0.001). However, there was no significant difference between the proportion of elevated protein content and the proportion of reduced glucose content in cerebrospinal fluid (χ²=0.023, P=0.879). ④Among the 90 children, blood culture results showed positive results in 11 cases (12.2%), while cerebrospinal fluid culture results showed positive in 1 case (1.1%). ⑤ MRI findings showed one child each with subdural effusion, ventriculomegaly, and hydrocephalus. ⑥ Among the 90 cases of children, 67 cases (74.4%) were cured and discharged, and 23 cases (25.6%) were improved and discharged.

The clinical manifestations of neonatal purulent meningitis are not typical. Newborns with high-risk factors, such as fever of unknown orgin and poor response should be take related examinations and treated as soon as possible so as to improve the prognosis.