101例儿童无菌性脑炎的临床特点分析  

The clinical features of 101 cases of children with aseptic encephalitis

作　　者：王贤柱 李玖军[1] 

机构地区：[1]中国医科大学附属盛京医院PICU,沈阳110004

出　　处：《中国小儿急救医学》2015年第4期266-269,共4页Chinese Pediatric Emergency Medicine

摘　　要：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。Objective To observe and discus the clinical features and outcome of aseptic encephalitis in children. Methods One hundred and one cases treated in PICU of Shengjing Hospital of China Medical 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 retrospectively. 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 electroencephalography（ 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 abnormal 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 abnormalities 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 treatment. 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 convulsion,EEG and MRI are with high sensitivity. Most patients have good outcome if received symptomatic treatment early. A few cases left neur

关 键 词：无菌性脑炎 儿童 

分 类 号：R742.9[医药卫生—神经病学与精神病学]