摘要
目的:探讨合并内耳畸形的儿童化脓性脑膜炎的临床特点,以提高儿科医师对该病早期识别的能力。方法:回顾性分析2010年4月至2020年3月重庆医科大学附属儿童医院神经内科诊断的合并内耳畸形(伴或不伴脑脊液漏)的儿童化脓性脑膜炎的临床特点及治疗转归。结果:共纳入10例患儿,男女比例9∶1,起病年龄7个月~14岁3个月(中位数7岁2个月),主要临床表现为发热10例(100%)、脑膜刺激征9例(90.00%)、头痛呕吐8例(80.00%)、惊厥2例(20.00%)。9例伴有先天性神经性耳聋。8例伴有脑脊液耳漏(其中2例合并脑脊液鼻漏),1例仅有鼻漏。影像学检查在9例患儿中发现5种类型的内耳结构异常,包括不完全分隔Ⅰ型2例、不完全分隔Ⅱ型(Mondini畸形)2例、完全性迷路发育不全(Michel畸形)1例、共同腔畸形1例及耳蜗发育不良5例,另外1例耳聋患儿仅见脑脊液鼻漏而影像学无异常。分别有4例血培养及2例脑脊液细菌培养阳性,均为肺炎链球菌,所有菌株对万古霉素、利奈唑胺、氯霉素敏感。9例患儿使用了二联及以上抗菌药物抗感染,依次为万古霉素(9例)、第三代头孢菌素(6例)、美罗培南(4例)。住院抗感染治疗时间14~74 d(中位数27 d)。6例为复发病例,均合并脑脊液耳漏或鼻漏,其中4例手术修复后未再复发。2例首次化脓性脑膜炎合并脑脊液耳漏患儿术后均未再复发。10例患儿经治疗后1例遗留右动眼神经麻痹,1例因脑积水放弃治疗,其余8例均预后良好。结论:合并内耳畸形的儿童化脓性脑膜炎以学龄期儿童常见,对万古霉素联合其他抗生素治疗反应好,对于化脓性脑膜炎合并脑脊液漏患儿,尤其复发患儿,宜尽早手术,以改善预后。
Objective:To probe into the clinical characteristics of purulent meningitis in children with inner ear malformation,so as to improve the ability of pediatricians to identify the disease early.Methods:The clinical characteristics and treatment prognosis of purulent meningitis in children with inner ear malformation(with or without cerebrospinal fluid leakage)diagnosed in neurology of Children’s Hospital of Chongqing Medical University from Apr.2010 to Mar.2020 were retrospectively analyzed.Results:A total of 10 children were enrolled,with the male to female ratio of 9∶1.The onset age ranged from 7 months to 14 years and 3 months(with median of 7 years and 2 months).The main clinical manifestations were fever in 10 cases(100%),meningeal irritation in 9 cases(90.00%),headache and vomiting in 8 cases(80.00%)and convulsions in 2 cases(20.00%).Nine cases were associated with congenital neurogenic deafness.There were 8 cases with cerebrospinal fluid ear leakage(two of them complicated with cerebrospinal fluid nasal leakage),and 1 case with nasal leakage only.Imaging examination revealed 5 types of inner ear malformation in 9 cases,including 2 cases of incomplete septationⅠ,2 cases of incomplete septationⅡ(Mondini malformation),1 case of complete labyrinthic dysplasia(Michel malformation),1 case of common cavity malformation and 5 cases of cochlear dysplasia.In one case of deafness,only cerebrospinal fluid nasal leakage was seen without imaging abnormalities.Four cases had positive blood cultures and 2 cases had positive cerebrospinal fluid bacterial cultures,all for Streptococcus pneumoniae,and all strains were sensitive to vancomycin,linezolid and chloramphenicol.Nine children were treated with two or more kinds of antibiotics for anti-infection,including vancomycin(9 cases),the third-generation cephalosporin(6 cases)and meropenem(4 cases).The duration of anti-infection treatment in hospital ranged from 14 to 74 d(with median of 27 d).Six cases were recurrent cases,all complicated with cerebrospinal fluid ear l
作者
廖双
洪思琦
蒋莉
罗媛媛
Liao Shuang;Hong Siqi;Jiang Li;Luo Yuanyuan(Children's Hospital of Chongqing Medical Universityt National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Ijaboraton of Pediatrics,Chongqing 400014,China)
出处
《儿科药学杂志》
CAS
2021年第6期18-21,共4页
Journal of Pediatric Pharmacy
关键词
内耳畸形
化脓性脑膜炎
脑脊液耳漏
儿童
inner ear malformation
purulent meningitis
cerebrospinal fluid leakage
children
