营养不良对儿童期细菌性脑膜炎直接预后的影响:孟加拉国一项基于医院的前瞻性队列研究

Md. Maniruzzaman, F. Mohsin, M. Nesa, A. Chakroborty, S. Zaman, S. El, Hadidy, A. Murtaza, Mohammad Abdul, Khaleque
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引用次数: 2

摘要

急性细菌性脑膜炎是世界范围内一种重要的严重疾病,造成儿童死亡率和发病率。在发达国家,只有5%的患者死亡,15-20%发展为后遗症,而在不发达国家,12-50%的患者死亡,25-50%的患者发展为后遗症。营养不良会使一个人更容易受到感染,而感染也会导致营养不良,从而导致恶性循环。2012年2月至2013年2月,在Mymensingh医学院和医院儿科进行了一项基于医院的前瞻性队列研究,以比较营养不良和营养良好儿童细菌性脑膜炎的直接结果。采用有目的抽样法,对30例营养良好和30例营养不良患者进行了研究。两组均以发热、惊厥、囟门隆起、行为异常、头痛及呼吸系统症状为主诉,营养不良组惊厥明显多于营养不良组。营养不良组入院时GCS大多<13,而营养良好组入院时GCS大多为13-15。脑脊液结果相似。大多数受感染的儿童患有贫血症。死亡12例(20%),严重后遗症14例(23%),轻微后遗症10例(17%)。营养不良组的相对死亡风险为5倍,其次为严重后遗症6倍,轻微后遗症4倍。营养不良组住院时间更长。这项研究表明,急性细菌性脑膜炎发生在所有年龄段,从1至12岁的男女儿童和5岁以下年龄组和男性中。发热、惊厥和脑膜刺激征象是主要的临床特征。本研究认为,死亡、严重或轻微神经系统后遗症多见于营养不良儿童和青少年、男性、贫血、年龄体重Z评分<-2SD/ BMI <第3个百分点、GCS< 13为不良预后因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effect of malnutrition on immediate outcome of childhood bacterial meningitis: a hospital based prospective cohort study in Bangladesh
Acute bacterial meningitis is an important serious illness worldwide and causing mortality and morbidity in children. In developed countries, only 5% of patients die and 15-20% develop sequel whereas in underdeveloped countries 12-50% of patients die and 25-50% of patients develop sequel. Malnutrition can make a person more susceptible to infection, and infection also contributes to malnutrition, which causes a vicious cycle. A hospital based prospective cohort study was conducted in the Pediatrics department of Mymensingh Medical College & Hospital from February 2012 to February 2013 to compare immediate outcome of bacterial meningitis: in malnourished and well nourished children. Thirty (30) cases of well-nourished and 30 malnourished were enrolled by using purposive sampling. Fever, convulsion, bulged fontanel, abnormal behavior, headache and respiratory symptoms were presenting complaints in both groups and convulsion was significantly more in malnourished group. In Malnourished group, GCS on admission was <13 in majority whereas among well-nourished group it was 13-15. CSF findings were similar. Most of the exposed children were anaemic. Total 12(20%) children died, 14(23%) developed major sequel, 10(17%) patients developed minor sequel. Relative risk of death was 5 fold followed by major sequel 6 fold and minor sequel 4 fold in malnourished group. Hospital stay was more in malnourished group. This study reveals that acute bacterial meningitis occurred in all ages from 1 to 12years child of both sexes and more in under five age group and in males. Fever, convulsion and sign of meningeal irritation were prominent clinical features. This study concludes that death, major and minor neurological sequel were more common in malnourished children and young age, male sex, anaemia, weight for age Z score <-2SD/ BMI <3rd percentile, GCS< 13 were the bad prognostic factors.
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