肠道感染相关性出血性休克与脑病综合征临床分析  

Clinical outcome of gut infection,associated hemorrhagic shock and encephalopathy syndrome

作　　者：何时军[1] 应立英[1] 张凤飞[1] 叶景[1] 南向珍[1] 韩国强[1] 

机构地区：[1]温州医学院附属育英儿童医院PICU,浙江温州325027

出　　处：《临床儿科杂志》2006年第7期579-582,共4页Journal of Clinical Pediatrics

摘　　要：目的探讨肠道感染相关的出血性休克与脑病综合征临床特点。方法分析12例与文献报道的出血性休克与脑病综合征相一致的患儿,均为突发昏迷和抽搐、高热、休克、水样腹泻、代谢性酸中毒、DIC、肝肾功能损害,前躯期为严重的水样便。结果大便检测3例轮状病毒阳性:高死亡率和严重的运动和语言障碍是其特点;极显著的肝酶学改变,血胆红素多正常。入院1～2d后肝转氨酶达高峰,多于1周内恢复正常;随着休克的纠正,肾功能于1～2d内转正常,病情缓解,但神经功能却发生进行性损害:发病后持续昏迷或频繁抽搐,肺出血,难以纠正的休克,持续无尿,出血不止,多于短期内死亡;本组死亡7例,4例留有严重的神经后遗症,1例神经功能正常。结论应提高对出血性休克与脑病综合征的临床认识。治疗关键是纠正休克,肠源性的全身炎症反应可能参与发病机制。Objective To explore clinical features of gut infection-associated hemorrhagic shock and encephalopathy syndrome （HSES）. Methods The clinical data were analyzed in 12 children whose clinical course and laboratory parameters were compatible with the diagnosis of HSES. The abrupt onset of symptoms including coma,seizures, hyperthermia, shock, diarrhea, acidosis, coagulopathy, and renal and hepatic dysfunction were observed in all cases following several days of prodromal illness with diarrhea and fever. Results Rotavirus in the stool was identified in 3 patients. The infection was characterized with high mortality and neurologic morbidity,the activities of aspartate aminotransferase and alanine aminotransferase increased markedly,but the plasma levels of bilirubin were generally normal. The abnormalities peak in the activities of hepatic aminotransferase was within 24 - 48 hours after admission ,reverted to normal level within one week for most of them. With shock improved,the renal function usually recovered normal within 1 - 2 days,while the neurologic condition was progressive deterioration. There was higher mortality with persistent coma,recurrent seizures, pulmonary hemorrhage,irreversible shock,persistent anuria,bleedings and multi-organ failure. Of the 12 cases,7 died,4 survived but with severe neurologic sequelae, only one case was normal neurologically. Conclusions It is important to enhance the awareness of hemorrhagic shock and encephalopathy syndrome clinically. To correct the circulation volume and hypoxemia is the key to cure HSES successfully. Systemic inflammatory response syndrome （SIRS） from gastrointestinal tract may contribute to HSES probably.

关 键 词：DIC 出血性休克与脑病综合征 肠道感染 

分 类 号：R725.1[医药卫生—儿科]