急性中枢神经系统病毒感染患儿的临床特征及影响预后的相关因素分析  

Clinical characteristics of children with acute central nervous system virus infection and influencing factors for prognosis

作　　者：吴维实 陈凤 陈海丹[1] 吴慧莲[1] 王兰英 陈金妮[2] WU Wei-shi;CHEN Feng;CHEN Hai-dan;WU Hui-lian;WANG Lan-ying;CHEN Jin-ni(Third People＇s Hospital of Hainan Province,Sanya,Hainan 572000,Chin)

机构地区：[1]海南省第三人民医院儿科,海南三亚572000 [2]海南省人民医院儿科,海南海口570311

出　　处：《中华医院感染学杂志》2018年第13期2033-2036,共4页Chinese Journal of Nosocomiology

基　　金：三亚市科技局科技计划基金资助项目(20140423)

摘　　要：目的探讨急性中枢神经系统(CNS)病毒感染患儿的临床特征及影响预后的相关因素。方法 2013年3月-2017年11月医院收治的急性CNS病毒感染的患儿200例,使用格拉斯哥预后评分(GOS)评价患者预后,对患儿临床资料和预后的关系进行分析。结果 200例患儿中预后良好180例(90.0%),预后不良20例(10.0%)。发热时间、脑脊液白细胞数、脑脊液蛋白量、EEG、颅脑影像学、脑膜刺激征、肌力异常、惊厥多次发作、早期意识障碍和惊厥性癫痫持续状态在预后良好患者和预后不良患者之间比较差异有统计学意义(P<0.05)。脑膜刺激征、惊厥多次发作、早期意识障碍和惊厥性癫痫持续状态(:2.542~4.368,P=0.008)是影响患儿预后的独立影响因素。结论脑膜刺激征、惊厥多次发作、早期意识障碍和惊厥性癫痫持续状态是影响患儿预后的独立影响因素,早期识别相关因素,并针对性给予积极治疗可改善患儿预后。OBJECTIVE To explore the clinical characteristics of children with acute central nervous system（CNS）virus infection and analyze the influencing factors for the prognosis.METHODS A total of 200children with acute CNS virus infection who were treated in the hospital from Mar 2013to Nov 2017were enrolled in the study,the prognosis of the patients was evaluated by using the Glasgow Outcome Scale（GOS）,and the correlation between clinical data and prognosis was observed.RESULTS Of the 200children,180（90.0%）had favorable prognosis,and 20（10.0%）had adverse prognosis.There were significant differences in fever time,white blood cells counts in cerebrospinal fluid,cerebrospinal fluid protein level,EEG,brain imaging,meningeal irritation,muscle abnormalities,multiple episodes of convulsions,early disturbance of consciousness and convulsive status epilepticus between the children with favorable prognosis and the children with adverse prognosis（P〈0.05）.The meningeal irritation（OR=0.961,95%CI：1.578-3.012,P=0.001）,multiple episodes of convulsions（OR=2.348：1.024-4.357,P=0.002）,early disturbance of consciousness（CI：1.444-3.647,P=0.011）and convulsive status epilepticus（OR=2.365,95%CI：2.542-4.368,P=0.008）were the independent influencing factors for the prognosis of the children.CONCLUSIONThe meningeal irritation,multiple episodes of convulsions,early disturbance of consciousness and convulsive status epilepticus are the independent influencing factors for the prognosis of the children,and it is an effective way to identify the high risk factors in early stage and take targeted treatment measures so as to improve the prognosis of the children.

关 键 词：中枢神经系统 病毒感染 预后 格拉斯哥预后评分 

分 类 号：R373[医药卫生—病原生物学]