摘要
背景小儿再发性化脓性脑膜炎(简称再发化脑)是一种儿童少见病,因其病因复杂、隐匿,极易被漏诊,及时早期发现和确诊对患儿的预后有重大意义,但目前国内外对小儿再发化脑的临床研究及病因分析较少。目的总结小儿再发化脑的病例特点、潜在病因及相应治疗方案。方法回顾性收集2012-2018年在河北省儿童医院神经内一科住院的15例再发化脑患儿的临床资料,根据可能的病因分别行颅脑+脊髓MRI、颞骨CT、听力筛查、免疫功能等检查。患儿每次发病均按标准化脓性脑膜炎治疗方案,予以抗生素治疗和脱水对症治疗,并根据病因进行针对性治疗。患儿出院后电话随访6个月~3年。结果15例再发化脑患儿中,男8例,女7例;首次发病年龄24 d~9岁,平均发病年龄(3.1±2.6)岁。患儿起病时间为4 h~10 d,均有发热、精神差表现。年长儿均有头痛、喷射性呕吐,而婴儿均有精神烦躁、前囟膨隆。15例患儿脑脊液培养均为阳性,其中8例血培养为阳性。15例再发化脑患儿的病因:先天性解剖结构异常7例(46.7%)(内耳畸形4例、藏毛窦2例、颅底筛板骨皮质不连续1例),头面部创伤后化脓性脑膜炎3例(20.0%)(创伤引起脑挫裂伤1例、创伤引起的脑脊液鼻漏1例、创伤引起鼓膜穿孔合并体液免疫缺陷病1例),临近组织炎症扩散2例(13.3%)(蜂窝织炎引起的蝶骨局部炎症包裹1例、脑脊液耳漏1例),严重并发症2例(13.3%),不明原因1例(6.7%)。给予急性期抗感染治疗,恢复期根据病情分别给予脓肿定向切除,脑脊液鼻漏、耳漏修补术,颅底修补手术,藏毛窦切除术,定期输注免疫球蛋白及保守治疗,随访6个月~3年未再复发。结论小儿再发化脑年龄可从新生儿期跨越至儿童期,病因复杂多样,解剖结构异常是造成再发化脑的主要因素。及时识别再发化脑,查找潜在的病因,去除病因,防止再发。
Background Recurrent purulent meningitis(RPM)is a rare disease in children,which is easily missed due to the complex and insidious etiology.So early detection and diagnosis in time has a positive impact on improving the prognosis.But there are few clinical studies and etiological analyses on RPM in children.Objective To study the clinical characteristics,possible causes and treatments of RPM.Methods Clinical data of 15 pediatric inpatients with RPM were collected retrospectively from Hebei Children's Hospital from 2012 to 2018.All cases underwent brain and spinal cord MRI,temporal bone CT scan,hearing screening or immune function test according to different possible causes of RPM,and received normal cerebral therapy(including antibiotic and dehydration treatment and so on),and treatment targeting the possible cause,as well as a postdischarge telephone follow-up ranging from 6 to 36 months.Results Of the 15 cases,8 were male and 7 female,with an age of first onset of 24 days to 9 years old,and an average age of onset of(3.1±2.6)years old.The time to onset ranged from 4 hours to 7 days,with presentations of fever and poor mental health status in all cases.Headache and jet vomiting were found in older children,while babies had irritability and bulging of the anterior fontanelle.Cerebrospinal fluid culture was positive in 15 cases,and blood culture was positive in 8 cases.The underlying causes of 15 cases of RPM:structural abnormality in 7 cases(46.7%)〔internal ear dysplasia(4 cases),pilonidal sinus(2 cases),discontinuous cortex of skull base ethmoid plate(1 case)〕,purulent meningitis after craniofacial trauma in 3 cases(20.0%)〔brain contusion and laceration(1 case),traumatic cerebrospinal fluid rhinorrhea(1 case),traumatic tympanic membrane perforation with humoral immunodeficiency(1 case)〕,adjacent tissue inflammation in 2 cases(13.3%)〔local inflammation of sphenoid bone caused by cellulitis(1 case),cerebrospinal fluid otorrhea(1 case)〕,serious complications(2 cases)and unknown cause(1 case).In the acu
作者
李鑫
孙素真
庞领玉
温鑫
王伟秀
LI Xin;SUN Suzhen;PANG Lingyu;WEN Xin;WANG Weixiu(Neurology Department 1,Hebei Children's Hospital,Shijiazhuang 050000,China;ENT Department,Hebei Children's Hospital,Shijiazhuang 050000,China;Department of Imaging,Hebei Children's Hospital,Shijiazhuang 050000,China)
出处
《中国全科医学》
CAS
北大核心
2021年第26期3392-3396,共5页
Chinese General Practice
基金
2019年度河北省医学科学研究课题计划(20190809)。
关键词
化脓性脑膜炎
再发性
病因
抗生素治疗
脱水治疗
抗感染治疗
Purulent meningitis
Recurrent
Etiology
Antibiotic treatment
Dehydration treatment
Anti-infective therapy
