| 摘要: |
| 目的：探讨血及脑脊液培养阴性的小儿化脓性脑膜炎121例的临床疗效，为临床经验用药提供依据。方法：回顾性分析我院2017年1月至6月收治的血及脑脊液培养阴性的化脓性脑膜炎患儿121例，根据治疗方法不同分为观察组和对照组。观察组68例，采用万古霉素联合头孢他啶治疗；对照组53例，采用头孢曲松联合青霉素常规治疗方案。观察两组患儿脑脊液的恢复、住院天数、费用及预后、药物不良反应情况。结果：观察组治疗7 d、14 d后复查脑脊液WBC均低于对照组（t=分别为-2.96、-3.72，P均<0.01）。两组患儿治疗7 d、14 d后复查脑脊液葡萄糖、蛋白水平比较差异均无统计学意义（P均>0.05）。观察组患儿的住院时间（15.16±0.47）d，短于对照组的（18.51±1.04）d（t=-2.95，P<0.01）；住院费用与对照组比较差异无统计学意义（t=0.72，P>0.05）。观察组治愈60例（88.2%），对照组治愈38例（71.7%），两组比较差异有统计学意义（χ2=4.52，P<0.05）。两组患儿均未出现脑室膜炎、脑积水及肝肾功能、心肌酶异常并发症，对照组出现4例出现胆囊病变，两组比较差异有统计学意义（P<0.05）。结论：万古霉素联合头孢他啶在小儿化脓性脑膜炎治疗中疗效显著，与常规治疗方法相比，强有力的抗生素可有效迅速改善脑脊液白细胞总数，缩短住院时间，减少并发症及后遗症的风险，值得临床推广应用。 |
| 关键词: 万古霉素 头孢他啶 小儿 化脓性脑膜炎 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2019.01.003 |
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| 基金项目:河北省医学科学研究重点课题计划，编号20160424 |
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| 121 Children with Purulent Meningitis Whose Blood and Cerebrospinal Fluid Cultures Were Negative |
| Wang Xin, Yang Huafang, Zhang Yu, Zheng Huacheng, Zhao Qing |
| (Hebei Children's Hospital, Hebei Shijiazhuang 050031, China) |
| Abstract: |
| Objective: To explore the effect of 121 children with purulent meningitis whose blood and cerebrospinal fluid cultures were negative, and provide reference for empirical antimicrobial regimens. Methods: One hundred and twenty-one children suffered from purulent meningitis who were accepted by our hospital from January to June of 2017 were chosen as the research subjects retrospectively. They were divided into observation group and control group. Patients in observation group were 68 cases which adopted the treatment of vancomycin combined with ceftazidime. While others in contrast group adopted the treatment of ceftriaxone combined with penicillin. Observe the recovery of cerebrospinal fluid, hospitalization days, cost, prognosis and drug adverse reactions in the two groups after the treatments. Results: Observation group and control group had no statistical significance in age, sex, body temperature on admission, vomiting, headache, convulsions, cerebrospinal fluid white blood cells (P>0.05). Cerebrospinal fluid white blood cells of observation group were obviously lower than the control group after 7 days treatment (t=2.962, P<0.01). On the 14th day after treatment, the difference between the two groups was also remarkable. The cerebrospinal fluid white blood cells of observation group were lower than the control group (t =3.717, P<0.01). The sugars of cerebrospinal fluid between observation group and control group in 7 and 14 days (t=-1.567, t=-1.117, P>0.05) showed no statistical significance. The proteins of cerebrospinal fluid between observation group and control group in 7 and 14 days (t=-1.332, t=-1.447, P>0.05) showed no statistical significance. Compared with the control group, the hospitalization time of observation group were obviously fewer(t=2.950, P<0.01). However, the cost between the two groups was no statistically significant (t=0.717, P>0.05). In observation group, 60 cases (88.2%) were cured and 12 cases (11.8%) were effective. While in the control group, 38 cases (73.1%) were cured and 14 cases (26.9%) were effective, one case (1.9%) was quitted therapy and exited our study. The total effective rate between the two groups was no statistically significant (P>0.05). But the cure rate of observation group was significantly higher than the control group, which was of a statistical significance (P<0.05). The complication between the two groups was no statistically significant (P>0.05). The hepatorenal function, blood and urine routine, auditory evoked potential of two groups before left the hospital were all normal. 4 cases in the control group suffered from cystic lesions which were a statistical significance (P<0.05). Conclusion: The clinical effect of vancomycin combined with ceftazidime in children of purulent meningitis was significantly, which not only could be rapidly improved of the cerebrospinal fluid, hospitalization days compared with conventional treatments, but also reduce the risk of complications and sequelae. It could be for reference in our clinical work. |
| Key words: vancomycin ceftazidime children purulent meningitis |
