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目的探讨B族链球菌相关的小婴儿化脓性脑膜炎(化脑)的临床特点及治疗。方法对天津市儿童医院2006年12月至2014年9月收治的22例<2月龄B族链球菌相关的化脑患儿的临床资料进行回顾性分析。结果 22例患儿的脑脊液均符合化脑的诊断标准,发病年龄12 h至2个月,其中<1月龄13例,≥1月龄9例,临床表现以发热为主,伴随嗜睡、抽搐、拒乳等表现;7例并发硬膜下积液(脓),4例中枢性呼吸衰竭,1例并发脑积水,1例并发脑脓肿,1例并发颅内出血;22例患儿均存在合并症,20例合并脓毒症,19例合并支气管肺炎,3例合并感染性休克。血常规白细胞升高9例,正常7例,降低6例,C反应蛋白、降钙素原、白介素-6等炎症指标明显升高;脑脊液常规10例白细胞计数(1400~15500)×1012/L不等,12例白细胞计数(16~872)×1012/L,均中性为主,生化葡萄糖<2.2 mmol/L 12例,正常10例,蛋白质>1 g/L 12例,血、脑脊液培养均B族链球菌阳性8例,仅脑脊液培养阳性3例,血培养B族链球菌阳性11例,体外药敏提示利奈唑胺、万古霉素、苄青霉素100%敏感,抗生素应用头孢吡肟/头孢曲松+青霉素及头孢曲松/美罗培南+万古霉素配伍治疗为主,7例硬膜下积液(脓)中4例进行硬膜下穿刺引流;20例好转出院,1例转脑外科手术治疗脑积水,1例死亡;随访时间2个月至7年,18例精神运动发育基本适龄于同龄儿,脑积水1例大运动及语言发育落后于同龄儿,2例失访。结论 B族链球菌是引起<2月龄新生儿和小婴儿化脑的主要致病菌,临床治疗困难者较多,重症病例比例高,尽早选择敏感抗生素治疗及做好预防很关键。
Objective To investigate the clinical features and treatment of purulent meningitis in children with B-streptococcal infection. Methods A retrospective analysis was performed on the clinical data of 22 children with <2 months of Group B Streptococcus pneumonia admitted to Tianjin Children’s Hospital from December 2006 to September 2014. Results All of the 22 children had cerebrospinal fluid (CSF) in accordance with the standard of diagnostic brain syndrome. The age ranged from 12 h to 2 months. Among them, 13 patients were younger than 1 month and 9 patients were ≥ 1 month old. The clinical manifestations were fever, drowsiness and convulsion , Breast rejection and so on; 7 cases of subdural effusion (pus), 4 cases of central respiratory failure, 1 case of hydrocephalus, 1 case of brain abscess, 1 case of intracranial hemorrhage; Complications, 20 with sepsis, 19 with bronchial pneumonia and 3 with septic shock. Nine cases of normal white blood cells, normal in 7 cases, decreased in 6 cases, C-reactive protein, procalcitonin, interleukin -6 and other inflammatory markers were significantly increased; routine cerebrospinal fluid 10 cases of white blood cell count (1400 ~ 15500) × 1012 / L There were 12 cases of leukocyte count (16 ~ 872) × 1012 / L, all of them were neutral, 12 cases of biochemical glucose <2.2 mmol / L, 10 cases of normal, 12 cases of protein> 1 g / B group streptococci were positive in 8 cases, only cerebrospinal fluid culture positive in 3 cases, blood culture group B streptococcal positive in 11 cases, in vitro susceptibility tips linezolid, vancomycin, benzylpenicillin 100% sensitive antibiotics cefepime / Ceftriaxone + penicillin and ceftriaxone / meropenem + vancomycin compatibility treatment, mainly in 7 cases of subdural effusion (pus) in 4 cases of subdural puncture and drainage; 20 cases were discharged, 1 case of brain One case died of surgical treatment of hydrocephalus. The follow-up time ranged from 2 months to 7 years. There were 18 cases of psychomotor development in the same age group. One case of hydrocephalus lagged behind the same age group and two cases lost speech . Conclusion Streptococcus group B is the main causative organ for neonates and infantile brains in <2 months old. There are more clinical treatments and a higher proportion of severe cases. It is very important to choose sensitive antibiotics as soon as possible and to prevent it.