24例头颅MRI异常的重症手足口病并脑干脑炎的临床分析  

Clinical analyses＇ of abnormal cranial magnetic resonance imaging of 24 cases of severe hand-footmounth diseases complicated with brainstem encephalitis

作　　者：臧平[1] 卢秀兰[1] 祝益民[1] 朱之尧[1] 

机构地区：[1]湖南省儿童医院重症医学科,长沙410007

出　　处：《中国医师杂志》2012年第11期1479-1482,共4页Journal of Chinese Physician

摘　　要：目的探讨头颅MRI异常的重症手足口病并脑干脑炎患儿的临床特点、诊治、预后及发生神经源性肺水肿（NPE）的关系。方法2010年5月至2010年10月入住本院ICU治疗的386重症手足口病患儿，其中头颅MRI异常24例，分析其临床表现、MRI特点、诊治及预后。结果24例重症手足口病并脑于脑炎患儿临床表现以发热、惊跳、嗜睡、呕吐、吞咽困难、流涎等为主。头颅MRI异常者NPE发生率高于头颅MRI正常者（5％VS6．5％，）（2=34．55，P〈0．01）。结论重症手足口病的神经系统受累部位主要为脑干、丘脑、脊髓。头颅MRI检查可早期发现脑干炎症者，需高度警惕NPE。病程第1～5天要特别注意上述神经系统症状，如能早期识别、及时干预治疗、阻止NPE发生，则预后良好。Objective To investigate the clinical features, treatment, prognosis, and occurrence of neurogenic pulmonary edema（NPE） in children with severe hand-foot-mouth disease （HFMD） complicated with brain stem encephalitis and abnormal cranial magnetic resonance imaging （MRI）. Methods 386 ca- ses of severe HFMD were hospitalized in our Intensive Care Unit （ICU） from May to October 2010, of which 24 cases had abnormal cranial MRI. Their clinical symptoms, MRI features, treatment, and prognosis were analyzed. Results The clinical symptoms of severe HFMD with brainstem encephalitis included fever, startle, lethargy, vomiting, difficulty swallowing, drooling, and so on. The patients with abnormal cranial MRI were prone to have a neurogenic pulmonary edema （NPE） （5% vs 6. 5% ,X2 =34. 55, P 〈 0. 01 ）. Conclusions The nervous system-affected parts of severe HFMD is the brain stem, thalamus, and spinal cord. Brain stem inflammation can be found early by the cranial MRI to be highly vigilant of NPE. During course of 1 - 5 day, special attention should be paid to the symptoms of the nervous system. The early detection, timely intervention, and prevention from NPE would result in the good prognosis.

关 键 词：手足VI彬并发症 危重病 脑干 脑炎 并发症 磁共振成像 

分 类 号：R725.1[医药卫生—儿科]