CAJ | 학술논문

目的：探讨无菌性脑炎的临床特点及转归情况。方法收集2009年12月至2012年12月中国医科大学附属盛京医院PICU收治的诊断为无菌性脑炎的患儿101例,对其临床表现、体征、辅助检查及转归情况进行回顾性分析。结果101例患儿中,男54例,女47例,年龄1~6个月12例,~1岁12例,~3岁36例,~6岁12例,~14岁19例。发热为最常见的临床表现,共有92例(91．1%),其次为抽搐79例(78．2%),脑膜刺激征或病理征阳性63例(62．4%)。辅助检查中敏感性最高的为脑电图,共89例患儿行脑电图检查,异常75例(84．3%),其次为MRI平扫,共97例行头部MRI平扫,异常54例(55．7%),101例患儿均行脑脊液检查,白细胞增高或(和)蛋白增高50例(49．5%),敏感性最低的为CT平扫,63例行头部CT平扫,异常11例(17．5%)。所有患儿入院后均给予止惊、退热、降低颅压及营养脑细胞等综合治疗,治愈70例,留有神经系统后遗症20例,放弃治疗7例,死亡4例。结论儿童无菌性脑炎好发于婴幼儿,男女发病率相当,临床表现呈多样化,以发热及抽搐最为常见,脑电图及头部MRI检查敏感性较高,给予及时对症治疗,大部分患儿转归良好,少数病例留有意识障碍及运动障碍等不同程度的神经系统后遗症,个别病例脑干受累,出现呼吸衰竭、神经源性休克等,最终导致患儿死亡。
목적：탐토무균성뇌염적림상특점급전귀정황。방법수집2009년12월지2012년12월중국의과대학부속성경의원PICU수치적진단위무균성뇌염적환인101례,대기림상표현、체정、보조검사급전귀정황진행회고성분석。결과101례환인중,남54례,녀47례,년령1~6개월12례,~1세12례,~3세36례,~6세12례,~14세19례。발열위최상견적림상표현,공유92례(91．1%),기차위추휵79례(78．2%),뇌막자격정혹병리정양성63례(62．4%)。보조검사중민감성최고적위뇌전도,공89례환인행뇌전도검사,이상75례(84．3%),기차위MRI평소,공97례행두부MRI평소,이상54례(55．7%),101례환인균행뇌척액검사,백세포증고혹(화)단백증고50례(49．5%),민감성최저적위CT평소,63례행두부CT평소,이상11례(17．5%)。소유환인입원후균급여지량、퇴열、강저로압급영양뇌세포등종합치료,치유70례,류유신경계통후유증20례,방기치료7례,사망4례。결론인동무균성뇌염호발우영유인,남녀발병솔상당,림상표현정다양화,이발열급추휵최위상견,뇌전도급두부MRI검사민감성교고,급여급시대증치료,대부분환인전귀량호,소수병례류유의식장애급운동장애등불동정도적신경계통후유증,개별병례뇌간수루,출현호흡쇠갈、신경원성휴극등,최종도치환인사망。
Objective To observe and discus the clinical features and outcome of aseptic encephali-tis in children. Methods One hundred and one cases treated in PICU of Shengjing Hospital of China Medi-cal University and diagnosed with aseptic encephalitis from December 2009 to December 2012 were enrolled. Results The clinical manifestations, signs, laboratory examinations and outcome were analyzed retrospec-tively. Among them, 54 cases were male,47 cases were female,12 cases aged from 1 month old to 6 months old,12 cases aged from 7 months old to 1 year old,36 cases aged from 2 years old to 3 years old,12 cases aged from 4 years old to 6 years old,19 cases aged from 7 years old to 14 years old. The fever was the most common clinical manifestation, a total of 92 cases ( 91. 1%) , followed by convulsions, a total of 79 cases (78. 2%),63 cases with meningeal irritation or pathological signs positive(62. 4%). The sensitivity of elec-troencephalography( EEG) was the highest for diagnosis of aseptic encephalitis,89 cases underwent EEG with abnormal rate of 84. 3%(75/101). Followed by head MRI scan,97 cases underwent head MRI scan with ab-normal rate of 55. 7%(54/101). All cases underwent cerebrospinal fluid examination,50 cases with white blood cells and(or) protein increased(49. 5%). The sensitivity of head CT scan was the lowest,the abnor-malities were found in 11 cases ( 17. 5%) among 63 cases underwent head CT scan. All cases were given comprehensive treatment of sedation, antifebrile, reducing intracranial pressure and nerve nutrational treat-ment. Seventy cases were cured,20 cases left neurological sequelae,7 cases gave up treatment,4 cases died. Conclusion The children aseptic encephalitis occurs in infants and young children,the incidence of male and female are equal. The clinical manifestations are diverse,the most common manifestations are fever and con-vulsion,EEG and MRI are with high sensitivity. Most patients have good outcome if received symptomatic treatment early. A few cases left neurological sequelae,such as consciousness and dyskinesia. Respiratory fail-ure,neurogenic shock,eventually death would occour if the brainstem was involved.