重症病毒性脑炎68例临床分析  

Clinical analysis of 68 patients with severe viral encephalitis

作　　者：余天浩[1] 孙恒斌[1] 牛程麟 吴哲 

机构地区：[1]南京医科大学附属脑科医院icu,210029 [2]南京医科大学附属脑科医院康复医学科

出　　处：《临床神经病学杂志》2016年第1期15-17,共3页Journal of Clinical Neurology

摘　　要：目的探讨重症病毒性脑炎患者的临床特点。方法对68例重症病毒性脑炎患者的临床资料进行回顾性分析。结果首发症状为发热60例(88.2%),头痛36例(52.9%),意识障碍66例(97.1%),癫痫50例(73.5%),精神症状29例(42.6%)。入院后查EEG异常44例,头颅CT或MRI有异常信号42例,腰穿CSF异常68例。予抗病毒、脱水、抗炎和对症支持治疗;其中伴发癫痫持续状态22例,予口服大仑丁联合静脉使用丙泊酚、咪达唑仑、氯硝安定等抗癫痫,其中5例患者予床边连续血液净化治疗。严重癫痫持续状态的患者在口服及静脉抗癫痫药物不能很好控制的情况下,使用床边连续血液净化治疗有较好的疗效。68例患者经治疗痊愈8例,好转45例,自动出院11例,死亡4例。结论重症病毒性脑炎患者,应在早期收入重症监护病房,给予全方位的治疗和监护。对于其中顽固的癫痫持续状态,尤其是MRI发现明显病变者,死亡率高,除常规的药物治疗外,床边连续血液净化治疗能明显提高生存率,改善预后。Objective To observe the clinical features of patients with severe viral encephalitis. Methods The clinical data of 68 patients with severe viral encephalitis were retrospectively analyzed. Results First symptoms were fever in 60 cases （88.2%） , headache in 36 cases （52.9%） , disturbance of consciousness in 66 cases （97.1%）, epilepsy in 50 cases （73.5%）, and mental symptoms in 29 eases （42.6%）. After admission, there were 44 cases of abnormal EEG, and 42 cases of abnormal signal in head CT or MRI, and 68 cases of abnormal cerebrospinal fluid. The treatment was anti-virus, dehydration, anti-inflammatory and sympptomatic supportive treamtment. There were 22 cases associated with status epilepticus, who treated with oral phenytoin sodium combined with intravenous use propofol, midazolam, clonazepam and other antiepileptic therapy, and 5 patients were treated by continuous blood purification. When patients with severe status status used the oral and intravenous anti epileptic drugs could not be well controlled, the use of continuous blood purification had a good effect. After treatment, 8 cases were cured, 45 patients were improved, 11 cases had discharged from hospital, 4 cases were died. Conclusions Severe viral encephalitis patients should admitted to the intensive care unit in the early stages, to give a full range of treatment and monitoring. The patients with refractory status epilepticus, especially who are found to be significantly diseased in MRI, have a high mortality rate. In addition to conventional drug treatment, the continuous blood Durification treatment can siznificantlv increase the survival rate and imorove the prognosis.

关 键 词：重症病毒性脑炎 癫痫持续状态 床边连续血液净化 

分 类 号：R512.3[医药卫生—内科学]