摘要
目的:探讨美罗培南治疗新生儿化脓性脑膜炎的临床疗效及不良预后危险因素。方法:选择2015年1月—2018年1月我院收治的新生儿化脓性脑膜炎患儿200例作为研究对象,根据随机数字表法原则分为对照组和观察组,各100例。对照组给予头孢曲松钠[50~80 mg/(kg·d)]治疗,观察组在对照组基础上联合美罗培南(29 mg/kg,每天2~3次)治疗,比较两组治疗前后硫化氢(H2S)、一氧化氮(NO)水平;查阅两组患儿病例,采用单因素及多因素Logistic回归分析不良预后危险因素。结果 :治疗后观察组血液及脑脊液H2S和NO水平均低于对照组,差异有统计学意义(P <0.05);200例患儿均顺利完成治疗,其中预后不良10例,预后良好190例,单因素及多因素Logistic回归分析发现,新生儿化脓性脑膜炎患儿预后与惊厥、休克、贫血、嗜睡、持续发热时间、脑脊液有核细胞数≥500×106/L、脑脊液蛋白质含量、脑脊液糖浓度、外周白细胞数过低或过高显著相关(P <0.05)。结论 :美罗培南有助于改善新生儿化脓性脑膜炎患儿的H2S和NO水平,但是患儿预后危险因素较多,应根据危险因素制定有效的措施权衡利弊,改善预后。
Objective:To investigate the clinical efficacy and adverse prognosis risk factors of meropenem in the treatment of neonatal purulent meningitis.Methods:200 children with neonatal purulent meningitis admitted to our hospital from January 2015 to January 2018 were selected as subjects investigated.According to the principle of random number table,the children were divided into a control group and an observation group,100 cases each.The children in the control group were treated with ceftriaxone sodium[50~80 mg/(kg·d)],and the children in the observation group were treated with meropenem(29 mg/kg,2 to 3 times a day)on the basis of the treatment in the control group.The levels of hydrogen sulfide(H2S)and nitric oxide(NO)before and after treatment were compared between the two groups.The cases in the two groups were consulted,and the risk factors of adverse prognosis were analyzed by univariate and multivariate logistic regression.Results:After treatment,the levels of H2S and NO in blood and cerebrospinal fluid in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).200 cases of children successfully completed the treatment,including 10 cases with adverse prognosis and 190 cases with good prognosis.The univariate and multivariate logistic regression analysis found that the prognosis of the patients with neonatal purulent meningitis was significantly correlated with convulsion,shock,anemia,lethargy,duration of fever,number of nucleated cells in cerebrospinal fluid(≥500×106/L),protein content in cerebrospinal fluid,sugar concentration in cerebrospinal fluid and low or high number of peripheral white blood cells(P<0.05).Conclusion:Meropenem is helpful in improving the levels of H2S and NO in children with neonatal purulent meningitis.However,there are many risk factors for prognosis in the children.Effective measures should be taken according to the risk factors to balance the advantages and disadvantages and improve the prognosis.
作者
李怀营
Li Huai-ying(NICU,Xuchang Central Hospital,Xuchang Henan 461000,China)
出处
《中国合理用药探索》
CAS
2019年第9期10-13,共4页
Chinese Journal of Rational Drug Use
