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目的探讨影响化脓性脑膜炎患儿近期不良预后的危险因素。方法回顾性分析2014年2月—2017年2月收治的化脓性脑膜炎患儿196例,根据出院时Glasgow临床结局评分将其分为预后良好组(n=159)和预后不良组(n=37),收集并记录患儿临床资料。计量资料比较采用t检验,计数资料比较采用χ2检验,单因素和多因素采用logistic回归分析,P<0.05为差异有统计学意义。结果低龄、惊厥、呕吐、意识障碍、抽搐、瞳孔异常、脑脊液培养阳性、脑脊液蛋白和脑脊液乳酸浓度高、脑脊液糖浓度低、血白细胞<4×10~9/L或>12×10~9/L、血钙<3.5 mmol/L、血钠<135 mmol/L、颅脑CT/MRI检查异常是造成化脓性脑膜炎患儿预后不佳的影响因素;logistic回归分析显示,低龄、意识障碍、瞳孔异常、脑脊液乳酸升高、血白细胞异常是造成化脓性脑膜炎患儿预后不佳的独立危险因素(均P<0.05)。结论低龄、意识障碍、瞳孔异常、脑脊液乳酸升高、血白细胞异常是造成化脓性脑膜炎患儿预后不佳的独立危险因素,尽早识别并及时采取防治措施对患儿疾病预后有利。
Objective To investigate the risk factors of adverse prognosis in children with purulent meningitis. Methods A total of 196 children with purulent meningitis admitted from February 2014 to February 2017 were retrospectively analyzed. According to the Glasgow clinical outcome at discharge, the patients were divided into two groups: the good prognosis group (n = 159) and the poor prognosis group (n = 37), collect and record the clinical data of children. Measurement data were compared using t test, count data were compared using χ2 test, single factor and multiple factors using logistic regression analysis, P <0.05 for the difference was statistically significant. Results Low age, convulsions, vomiting, disturbance of consciousness, convulsions, pupillary abnormalities, positive culture of cerebrospinal fluid, high concentration of cerebrospinal fluid protein and cerebrospinal fluid, low cerebrospinal fluid glucose concentration, white blood cells less than 4 × 10 9 / L or more than 12 × 10 9 / L, serum calcium <3.5 mmol / L, serum sodium <135 mmol / L, brain CT / MRI abnormalities in children with purulent meningitis caused by poor prognosis; logistic regression analysis showed that young age, disturbance of consciousness, Pupillary abnormalities, elevated cerebrospinal fluid lactate, abnormal white blood cells were independent risk factors for poor prognosis in children with purulent meningitis (all P <0.05). Conclusion Low age, unconsciousness, pupillary abnormalities, elevated cerebrospinal fluid lactate, abnormal white blood cells are the independent risk factors for the poor prognosis of children with purulent meningitis. Early identification and prompt prevention and treatment measures are beneficial to the prognosis of children.