婴儿化脓性脑膜炎并发硬膜下积液早期诊断规范.doc

作者介绍：蓝明平，Email： HYPERLINK mailto:372847659@ 372847659@， 研究方向：小儿神经系统疾病。 通信作者：蒋 莉， Email： HYPERLINK mailto:dr_jiangli@126.com dr_jiangli@126.com。 婴儿化脓性脑膜炎并发硬膜下积液的早期诊断 蓝明平，蒋 莉 （重庆医科大学附属儿童医院神经内科,重庆 400014） 【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01月至2013年09月于重庆医科大学附属儿童医院诊断的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两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 /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。 【关键词】化脓性脑膜炎；硬膜下积液；早期诊断 【中图分类号】R725 【文献标志码】A 【收稿日期】2014-03-07 Early diagnosis of purulent meningitis complicated with subdural effusion Lan Mingping, Jiang Li （Department of Neurology, the Children’s Hospital,Chongqing Medical University） 【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 with PM complicated with SE，while the other randomly selected 129 children were 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 fontanelle 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 an