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目的探讨细菌性脑膜炎并脑积水的临床特点,并分析其相关的危险因素,以降低其发生率,改善细菌性脑膜炎的预后。方法对2004年1月-2010年6月本院收治的111例细菌性脑膜炎患儿的临床资料进行回顾性分析。根据影像学结果,将患儿分为细菌性脑膜炎并脑积水组(n=16)及细菌性脑膜炎无脑积水组(n=95),应用SPSS 17.0软件对2组患儿的基本情况、临床表现、实验室结果及抗生素治疗情况等进行比较,对相关因素进行Logistic回归分析,筛选出脑积水发生的高危因素。结果细菌性脑膜炎并脑积水的发生率为14.4%(16/111例),以梗阻性脑积水为主(14/16例,87.5%),75%(12/16例)患儿脑积水出现在起病4周内,确诊时CT/MRI的检查次数为1～3次,2例患儿在起病后2个月行脑室-腹腔分流术,2例脑积水患儿死亡。2组临床资料比较显示年龄、发热>10 d、惊厥、意识障碍、经验性治疗失败、颅内低密度灶、低Hb水平、高脑脊液蛋白水平、低脑脊液葡萄糖水平均与脑积水发生有关(Pa<0.05),Logistic回归分析显示意识障碍、经验性治疗失败、低Hb水平是细菌性脑膜炎并脑积水的独立危险因素。结论脑积水是细菌性脑膜炎的一个严重并发症之一,临床表现及实验室检查结果可作为细菌性脑膜炎并脑积水的预测指标。
Objective To investigate the clinical features of bacterial meningitis and hydrocephalus and to analyze the related risk factors so as to reduce its incidence and improve the prognosis of bacterial meningitis. Methods The clinical data of 111 children with bacterial meningitis treated in our hospital from January 2004 to June 2010 were analyzed retrospectively. According to the imaging findings, the children were divided into bacterial meningitis and hydrocephalus group (n = 16) and bacterial meningitis without hydrocephalus group (n = 95). SPSS 17.0 software was used to compare Basic conditions, clinical manifestations, laboratory results and antibiotic treatment were compared, Logistic regression analysis of relevant factors, screening out the risk factors for hydrocephalus. Results The incidence of bacterial meningitis and hydrocephalus was 14.4% (16/111 cases), mainly obstructive hydrocephalus (14/16 cases, 87.5%) and 75% (12/16 cases) Hydrocephalus occurred within 4 weeks of onset, CT / MRI examination confirmed the number of 1 to 3 times, 2 patients 2 months after onset of ventricular-peritoneal shunt, 2 cases of children with hydrocephalus death. The clinical data of two groups showed that age, fever> 10 days, convulsion, disturbance of consciousness, failure of empirical treatment, intracranial low density lesions, low Hb level, high cerebrospinal fluid protein level, low cerebrospinal fluid glucose level were all associated with hydrocephalus Pa <0.05). Logistic regression analysis showed that disturbance of consciousness, failure of empirical therapy and low Hb level were independent risk factors for bacterial meningitis and hydrocephalus. Conclusions Hydrocephalus is one of the serious complications of bacterial meningitis. Clinical manifestations and laboratory tests can be used as predictors of bacterial meningitis and hydrocephalus.