三例儿童新型冠状病毒感染相关重症脑病并文献分析  

Clinical features of three children with severe COVID-19 encephalopathy and literature review

作　　者：张涛[1] 王丽杰[1] 许巍[1] 杨男[1] 裴亮[1] 刘春峰[1] Zhang Tao;Wang Lijie;Xu Wei;Yang Nan;Pei Liang;Liu Chunfeng(Department of Pediatrics,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院儿科,沈阳110004

出　　处：《中国小儿急救医学》2023年第3期166-170,共5页Chinese Pediatric Emergency Medicine

基　　金：辽宁省科技重大专项计划(2020JH1/10300001);中国医科大学附属盛京医院345人才工程;沈阳市科技攻关项目(20-205-4-002)。

摘　　要：目的总结分析儿童新型冠状病毒感染相关重症脑病的临床特征和诊疗经过,提高临床医生对该疾病的认识。方法回顾性分析2022年12月1日至2022年12月31日中国医科大学附属盛京医院儿童重症监护病房收治的3例新型冠状病毒感染相关重症脑病患儿的临床特征、实验室检查、影像学资料及诊疗经过。结果3例患儿中,女2例,发病年龄2~11岁,均为急性起病,病史2~3 d,均有高热(≥40℃)、抽搐及意识障碍临床表现,新型冠状病毒核酸及抗原检测均为阳性,1例肺炎支原体IgM抗体阳性。3例患儿入院24 h内血常规白细胞水平均基本正常,中性粒细胞为主,降钙素原明显升高;血液总T细胞和NK细胞均明显降低,血氨、血糖及胆红素水平均基本正常;疾病早期脑脊液检查细胞数正常,蛋白均明显增高,头磁共振影像学均有新发对称性病灶。予对症及脑保护治疗,并早期应用激素、人丙种球蛋白及血浆置换疗法后,3例患儿均存活,但神经系统都合并有不同程度新发功能障碍。结论儿童新型冠状病毒感染相关重症脑病可发生于新型冠状病毒感染的急性期,多表现为高热、抽搐和严重意识障碍,可合并有多脏器功能障碍,且多存在不可逆的神经系统损伤,早期支持治疗、脑保护治疗和免疫治疗有助于改善患儿预后。Objective To analyze the clinical characteristics,diagnosis and treatment of 3 children with severe COVID-19 encephalopathy,aiming to improve the clinicians′understanding of the disease.Methods The clinical features,laboratory examinations,imaging data and diagnosis as well as treatment process of 3 cases of severe COVID-19 encephalopathy admitted to the Pediatric Intensive Care Unit of Shengjing Hospital of China Medical University from December 1,2022 to December 31,2022 were retrospectively analyzed.Results Among the 3 patients,2 were female,age was 2-11 years old,all of them had 2-3 days of medical history.All of them had clinical manifestations of high fever(≥40℃),convulsions and consciousness disorders,nucleic acid and antigen tests of SARS-CoV-2 were positive,and mycoplasma pneumonia IgM antibody was positive in 1 case.Within 24 hours after admission,the levels of white blood cells were basically normal,neutrophil fraction was dominant,and procalcitonin was significantly increased.Total T cells and NK cells in the blood of the three patients were significantly decreased,and the levels of blood ammonia,blood glucose and bilirubin were basically normal.During the early stage of the disease,the cell counts of the cerebrospinal fluid was normal in all three patients,the protein level was significantly increased,and there were new symmetrical lesions on head magnetic resonance imaging in 3 patients.After symptomatic treatment and immunotherapy including early use of hormone,human gamma globulin and plasma exchange,all patients were survived,but had different degrees of new dysfunction of the nervous system.Conclusion Severe COVID-19 encephalopathy can occur in the acute phase of SARS-CoV-2 infection,mostly manifested as high fever,convulsions and severe disturbance of consciousness,combining with multiple organ dysfunction and irreversible nervous system damage.Early supportive treatment,brain protective treatment and immunotherapy are helpful to improve the prognosis of the patients.

关 键 词：新型冠状病毒 神经系统 脑病 儿童 

分 类 号：R725.1[医药卫生—儿科]