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目的 评价细菌性脑膜炎患儿脑脊液内谷氨酸盐升高与发生惊厥或其他神经系统后遗症的关系。设计 前瞻性的对照定群研究。地点 拥有 36张床位的儿童重症监护病房和初级儿科转诊中心。患儿 1999～ 2 0 0 1年 5 5名因可疑脑膜炎而行腰穿的 0～ 18岁患儿。方法与结果 2 3名经脑脊液 /血培养及脑脊液白细胞增高诊断为细菌性脑膜炎的患儿为试验组 ,对照组 32例。试验组年龄中位数 1岁(0～ 15 2岁 ) ,对照组 0 3岁 (0～ 17岁 )。试验组脑脊液平均白细胞数 2 70 7± 3897,对照组 14 8± 2 5 9(P <0 0 1)。试验组脑脊液谷氨酸盐平均水平 (6 0 5± 88 4 )mol/L ,对照组为 (4 9± 11)mol/L(P <0 0 1)。 2 3例脑膜炎患儿仅 10例作了第 2次腰穿。试验组与对照组均显示脑脊液白细胞数与谷氨酸盐含量无关。尽管对照组部分患儿脑脊液谷氨酸盐含量升高 ,但无一例发生惊厥或遗留神经系统后遗症。试验组 4例于入院后发生惊厥 ,10例因此次感染于出院时留有神经系统后遗症。 2 / 3的脑膜炎患儿发生惊厥 ,且复查腰穿显示脑脊液谷氨酸盐水平持续升高。肺炎链球菌脑膜炎患儿 70 %发生神经系统合并症 (P =0 0 4 )。结论 细菌性脑膜炎患儿脑脊液中谷氨酸盐含量升高 ,且部分患者持续时间较长。然而本研究显示脑脊液谷?
Objective To evaluate the relationship between cerebrospinal fluid glutamate uptake and seizures or other neurological sequelae in children with bacterial meningitis. A prospective, controlled, population-based study was designed. Location A 36-bed child ICU and primary pediatric referral center. Children aged 0 ~ 18 years old with lumbar puncture due to suspected meningitis from 1999 to 2001. Methods and Results Twenty-three children diagnosed as bacterial meningitis by cerebrospinal fluid / blood culture and cerebrospinal fluid leukocytosis were experimental group and control group. The median age of the experimental group was 1 year old (0-15 years old), while the control group was 0-3 years old (0-17 years old). The mean leukocyte count in the test group was 2 70 7 ± 3897 and in the control group 14 8 ± 259 (P 0 01). The mean level of glutamate in cerebrospinal fluid of the experimental group was (65 ± 88 4) mol / L and that of the control group was (49 ± 11) mol / L (P <0.01). Only 2 of 23 children with meningitis had a second lumbar puncture. The experimental group and the control group showed that the number of cerebrospinal fluid leukocytes was not related to the content of glutamate. Although some patients in the control group had elevated cerebrospinal fluid glutamate levels, none of them had convulsions or a legacy of neurological sequelae. In the experimental group, 4 patients developed convulsions after admission, and 10 patients had the neurological sequelae after discharge from this hospital. Two thirds of children with meningitis developed convulsions, and the review of lumbar puncture showed that cerebrospinal fluid glutamate levels continued to rise. 70% of children with pneumococcal meningitis developed neurological complications (P = 0 0 4). Conclusion The content of glutamate in cerebrospinal fluid of children with bacterial meningitis increased, and some patients last longer. However, this study shows cerebrospinal fluid Valley?