持续视频脑电监测对重型单纯疱疹病毒性脑炎早期诊断和预后的意义  

Significance of Early Diagnosis and Prognosis of Severe Herpes Simplex Encephalitis by Continuous Video-electroencephalogram

作　　者：汪叶松[1] 李媛媛[2] 邓艳春[1] 

机构地区：[1]第四军医大学西京医院,西安710032 [2]浙江大学医学院附属第二医院

出　　处：《内科急危重症杂志》2009年第6期308-309,328,共3页Journal of Critical Care In Internal Medicine

摘　　要：目的:分析应用持续视频脑电监测对急性重型单纯疱疹病毒性脑炎早期诊断和预后的影响。方法:对25例伴有意识障碍的临床诊断急性重型单纯疱疹病毒性脑炎患者,入院24h内及入院后1周左右各进行长达8h以上的持续视频脑电监测(CEEG)并与记录的体征及CT等相关检查相比较。结果:入院24h内25例患者中脑电监测以弥漫性θ波为主的7例;以弥漫性σ波为主的4例;以а波为主,并有阵发性θ或σ波的5例;以局限性θ或σ波为主的9例,其中局限于颞额导的6例。25例中脑电监测出现痫性放电的14例,其中局限于颞额导的9例。连续痫性放电达1min以上4例。临床发作13例。癫痫持续状态5例。25例患者行头颅CT或MRI检查,14例患者提示有异常低密度病灶,颞叶病灶12例,额叶颞叶病变5例。治疗1周后19例患者的脑电均有恢复。其中16例患者以弥漫性θ波为主,9例患者以弥漫性а波为主,并有阵发性的θ或σ节律慢波。25例患者中痊愈19例;1例器质性精神障碍;2例认知范围缩窄;3例患者中途放弃治疗,均为入院以低波幅σ波为主,其中2例系入院时即表现为去脑强直状态。结论:持续脑电监测对单纯疱疹病毒性脑炎早期诊断具有一定的价值,并对其预后具有一定的预测价值。Objective： To investigate the early diagnosis and prognosis of severe herpes simplex encephalitis （HSE） by continuous video-electroencephalogram （CEEG）. Methods： Twenty-five patients with conscious disturbante in NICU were studied during the 24 hours after admission and a week later, CEEG of 25 HSE patients overtopping 8 hours were analyzed and compared with CT and clinical signs. Results： Within 24 hours after admission, the abnormal EEGs were classified into diffused θ wave in 7 eases, diffused σ wave in 4 cases, majorly a wave and paroxysm θ or σ wave in 5 cases, limited θ or σ wave in 9 cases, of which 6 cases CEEG were limited at pars temporal and frontal region. There were 14 cases whose CEEG appeared epileptic discharge, of which 9 cases＂ CEEG was limited at pars temporal and frontal region. Four eases＂ CEEG appeared continuous epileptic discharge and the time exceeded one minute, 13 cases had clinical seizure, 5 patients had status epilepticus. All patients were undergone CT or MRI examination, fourteen cases had abnormal low-density pathological changes, temporal lobe in 12 cases, frontal lobe and temporal lobe in 5 cases. After a weeks treatment, 19 patients＂ CEEG was improved, of which diffused θ wave in 16 cases, diffused a wave in 9 cases. At last, 19 patients were recovered, 1 patient has organic psychosis, 2 patients have cognitive handicap, 3 patients refused further treatment, of which 2 patients appear decerebrate rigidity, these 3 patients＂ CEEG showed diffused slow wave on admission. Conclusions. CEEG may help the early diagnosis and the evaluation of the prognosis of severe HSE.

关 键 词：单纯疱疹病毒性脑炎 持续视频脑电描记 

分 类 号：R742[医药卫生—神经病学与精神病学]