地塞米松在婴幼儿和儿童化脓性脑膜炎治疗中的作用

Pediatrie Pub Date : 1993-01-01
E Grimprel, P Bégué
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引用次数: 0

摘要

越来越多的证据表明,炎症过程是造成儿童和婴儿细菌性脑膜炎的神经损伤和后遗症的原因。细菌细胞壁成分(脂多糖、酸质聚合物)的大量释放引起一系列反应,包括许多细胞因子(如TNF α和IL-1 β)和前列腺素(如PAF和PGE2)的分泌,从而导致脑水肿、颅内高压和脑血流量减少。地塞米松(DXM)在炎症级联开始时有效,在脑膜炎动物实验模型中使用地塞米松可显著减少细菌性脑膜炎的炎症反应。首次临床研究表明,在儿童和婴儿流感嗜血杆菌脑膜炎的并发症和长期神经系统后遗症方面,使用ddxm作为抗生素辅助治疗的有益效果。脑膜炎球菌性脑膜炎和肺炎球菌性脑膜炎似乎也有类似的效果。关于在耐青霉素肺炎球菌性脑膜炎中使用DXM的信息实际上很少。用头孢曲松治疗耐青霉素肺炎球菌性脑膜炎的罕见病例中,使用万古霉素治疗效果良好。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[Role of dexamethasone in the treatment of purulent meningitis in infants and in children].

Accumulating evidence tends to demonstrate that inflammatory processes are responsible for neurological damage and sequelae in bacterial meningitis in children and infants. Massive liberation of bacterial cell wall components (Lipopolysaccharide, acid teichoic polymers) induce a cascade of reactions including the secretion of many cytokines (such as TNF alpha and IL-1 beta) and prostaglandins (such as PAF and PGE2) which in turn leads to the development of cerebral oedema, intracranial hypertension and cerebral blood flow reduction. Dexamethasone (DXM) is effective at the beginning of the inflammatory cascade and its utilisation in the meningitis experimental model in animals has shown significant reduction in the inflammatory response to bacterial meningitis. The first clinical studies using DXM as an adjunctive therapy to antibiotics have demonstrated its beneficial effect in terms of complications and long-term neurological sequelae in Haemophilus influenzae meningitis in children and infants. It seems that a similar effect can be obtained in meningococcal and pneumococcal meningitis. Little information is actually available concerning the use of DXM in penicillin-resistant pneumococcal meningitis. The rare reported cases of ceftriaxone failure with DXM as treatment of penicillin-resistant pneumococcal meningitis had a favorable outcome with the use of vancomycin.

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