摘要
目的 探讨化脓性脑膜炎(PM)患儿并发脑积水的危险因素.方法 选择2018年1月至2022年6月驻马店市中心医院收治的300例PM患儿为研究对象,根据是否并发脑积水将患儿分为并发脑积水组(n=30)和非脑积水组(n=270).采用单因素和多因素logistic回归分析PM患儿并发脑积水的危险因素.结果 单因素分析结果显示,PM患儿的居住环境、确诊前是否使用抗生素、初始治疗使用抗生素数量、是否使用地塞米松、入院前惊厥发作、意识障碍、细菌培养结果、首次脑脊液(CSF)中白细胞计数、首次CSF中葡萄糖水平、首次CSF中蛋白质水平、血清CRP水平与PM患儿并发脑积水有关(P＜0.05).多因素logistic回归分析结果显示,居住在农村、确诊前使用抗生素、使用地塞米松、意识障碍、首次CSF中蛋白质水平高、血清CRP水平高是PM患儿并发脑积水的独立危险因素(P＜0.05);初始治疗采用2种抗生素是PM患儿并发脑积水的保护因素(P＜0.05).结论 居住在农村、确诊前使用抗生素、使用地塞米松、意识障碍和首次CSF中蛋白质水平高、血清CRP水平高的PM患儿并发脑积水的风险较高,初始治疗采用2种抗生素可降低PM患儿并发脑积水的风险.
Abstract
Objective To explore the risk factors and preventive measures of concurrent hydrocephalus in children with purulent meningitis(PM).Methods Three hundred children with PM who were treated in Zhumadian Central Hospital from January 2018 to June 2022 were collected,and they were divided into the combined hydrocephalus group(n=30)and non-hydrocephalus group(n=270)according to whether the children complicated with hydrocephalus.Risk factors for concur-rent hydrocephalus in children with PM were analyzed by using univariate analysis multifactorial logistic regression.Results Living environment,use of antibiotics before diagnosis or not,number of antibiotics used for initial treatment,dexamethasone use or not,convulsive seizures before admission,impaired consciousness,bacterial culture results,white blood cell count in the first CSF,glucose level in the first CSF,protein level in the first CSF,and serum CRP level were associated with concomitant hydrocephalus in children with PM(P＜0.05).The results of multivariate logistic regression analysis showed that the inde-pendent risk factors for complicated hydrocephalus in children with PM included living in rural area,use of antibiotic before diagnosis,use of dexamethasone,impaired consciousness,high protein level in the first CSF,and high serum CRP level(P＜0.05),and the use of two antibiotics in the initial treatment was a protective factor for complicated hydrocephalus in children with PM(P＜0.05).Conclusion Risk factors for concurrent hydrocephalus in children with PM include rural residence,antibiotic use prior to diagnosis,dexamethasone use,impaired consciousness,high protein level in the first CSF,and high serum CRP level,and the use of two antibiotics for initial treatment is a protective factor for concurrent hydrocephalus in children with PM.
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