危重中枢神经系统感染患儿脑血管病变的临床研究  

A clinical study of vasculopathy of central nervous system infections in critically ill children

作　　者：李艳[1] 高恒妙[1] 刘珺[1] 王晓晖[1] 肖宁宁 钱素云[1] Li Yan;Gao Hengmiao;Liu Jun;Wang Xiaohui;Xiao Ningning;Qian Suyun(Pediatric Intensive Care Unit,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院重症医学科,北京100045

出　　处：《中华实用儿科临床杂志》2020年第12期903-906,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨危重中枢神经系统(CNS)感染患儿脑血管病变情况。方法回顾性分析2017年7月至2018年10月北京儿童医院重症监护病房收治的需机械通气的43例CNS感染患儿临床资料,并对每例患儿采用经颅多普勒超声(TCD)检测双侧大脑中动脉的收缩期峰流速、搏动指数等,并结合头部CT或磁共振成像等影像学表现了解其脑血管病变情况。结果43例患儿中TCD检查正常11例,异常32例。TCD异常患儿中流速增快27例,流速减低5例。在流速增快的27例患儿中,符合血管痉挛标准者15例;流速减低的5例中4例呈震荡波。全部患儿中21例(48.9%)有脑缺氧缺血性表现,6例(13.9%)出现脑出血(其中5例同时合并脑缺血),2例(4.7%)住院期间即合并脑软化。全部患儿中共20例完成了头部磁共振血管成像,其中异常14例(70%)。出院时预后不良共32例(74.4%),其中死亡或脑死亡10例(23.3%,10/32例)。结论危重CNS感染患儿较多出现脑血流动力学异常及缺血性改变,其中达到血管痉挛者或流速度减低者预后最差。Objective To explore the vasculopathy of central nervous system(CNS)infections in critically ill children.Methods The clinical data of 43 children with CNS infections requiring mechanical ventilation admitted to the Intensive Care Unit of Beijing Children′s Hospital from July 2017 to October 2018 were analyzed retrospectively.The peak systolic velocity and the pulsatility index of the bilateral middle cerebral artery in each child were detected by Transcranial Doppler(TCD),and the vasculopathy was explored by combining with the imaging manifestations such as computed tomography or magnetic resonance imaging.Results TCD results were normal in 11 cases and abnormal in 32 cases.In the abnormal group,the cerebral blood flow velocity increased in 27 cases and decreased in 5 cases.Of the 27 cases with increased velocity,15 cases met the criteria of vasospasm,and 4 of the 5 cases with decreased velocity showed shock waves.Among all patients,21 cases(48.9%)had cerebral hypoxic-ischemic manifestations,6 cases(13.9%)had cerebral hemorrhage(5 cases were accompanied with cerebral ischemia),and 2 cases(4.7%)were complicated with cerebral malacia during hospitalization.Twenty cases in all of them had completed magnetic resonance angiography,which was abnormal in 14 cases(70%).There were 32 cases(74.4%)with poor prognosis at discharge,including 10 cases of death or brain death(23.3%,10/32 cases).Conclusions Cerebral hemodynamic abnormalities and ischemic changes are more common in children with severe encephalitis.Patients with vasospasm or decreased flow velocity have the worst prognosis.

关 键 词：中枢神经系统感染 超声检查 多普勒 经颅 儿童 

分 类 号：R742.9[医药卫生—神经病学与精神病学] R743[医药卫生—临床医学]