不同中心体温亚低温治疗儿童流感相关脑病/脑炎的临床效果和影响因素  

Clinical efficacy and influencing factors of mild therapeutic hypothermia for influenza-associated encephalopathy/encephalitis in children with different center temperatures

作　　者：林雨焮 冯骁 林辰曦 张明[1] 陈凌[1] LIN Yu-xin;FENG Xiao;LIN Chen-xi;ZHANG Ming;CHEN Ling(Department of Pediatrics,Zhongshan Hospital,Xiamen University,Xiamen,Fujian 361004,China)

机构地区：[1]厦门大学附属中山医院儿科,福建厦门361004

出　　处：《中国热带医学》2023年第6期637-642,651,共7页China Tropical Medicine

摘　　要：目的探索不同中心体温亚低温治疗儿童流感相关性脑病/脑炎(influenza associated encephalopathy/encephalitis,IAE)的临床效果及影响因素,为新的亚低温治疗方案提供思路和参考。方法收集2019年1月—2022年2月在厦门大学附属中山医院住院的115例拟接受亚低温治疗的IAE患儿作为研究对象,通过随机分组方式分为33℃组(60例)和35℃组(55例),分析两组的临床特征和亚低温临床疗效,对6个月神经系统伤残情况进行单因素及多因素logistic回归分析。结果两组治疗后基线指标方面,包括格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分、脑脊液总蛋白(cerebrospinal fluid total protein,CSF-TP)、脑脊液乳酸脱氢酶(cerebrospinal fluid lactate dehydrogenase,CSF-LDH)、淋巴细胞(lymphocyte,Lym)、肌酸激酶同工酶(creatine kinase-MB,CK-MB)、乳酸脱氢酶(lactate dehydrogenase,LDH)和神经元特异性烯醇化酶(neuron specific enolase,NSE),差异均无统计学意义(P>0.05);两组治疗后临床疗效指标方面,包括GCS评分差值、住院时间、6个月神经系统伤残发生率和改良Rankin量表(modified Rankin scale,mRS)评分、CSF-TP差值、CSF-LDH差值、Lym差值、CK-MB差值、LDH差值、NSE差值、脑电图和颅脑磁共振改善率,差异均无统计学意义(P>0.05)。单因素和多因素logistic回归分析[OR=1.185,95%CI(1.026~1.369),P=0.021]提示首次亚低温治疗时间迟是IAE患儿接受亚低温治疗后6个月发生神经系统伤残的独立危险因素。结论33℃与35℃儿童IAE亚低温治疗的临床疗效无显著差异,应用亚低温治疗IAE患儿时可适当放宽对中心体温的要求,及时接受亚低温治疗是降低IAE患儿神经系统伤残风险的关键措施。Objective To investigate the clinical outcomes and influencing factors of mild therapeutic hypothermia for influenza-associated encephalopathy/encephalitis(IAE)in children with different center temperatures,and to provide ideas and references for new mild therapeutic hypothermia scheme.Methods A total of 115 hospitalized children with IAE who were scheduled to receive mild therapeutic hypothermia in Zhongshan Hospital Affiliated to Xiamen University from January 2019 to February 2022 were collected as subjects.They were randomly divided into two groups,namely,the 33℃group(n=60)and the 35℃group(n=55).The clinical features and clinical outcomes of the two groups were analyzed.Univariate and multivariate logistic regression analysis was performed for 6-month to investigate the factors affecting neurological disability.Results The baseline indicators after treatment,such as Glasgow Coma Scale(GCS)score,cerebrospinal fluid total protein(CSF-TP),CSF lactate dehydrogenase(CSF-LDH),lymphocyte(Lym),creatine kinase-MB(CK-MB),LDH,and neuronspecific enolase(NSE),revealed no significant differences between the two groups before treatment or after treatment(P>0.05).There was no significant difference between the two groups after treatment in the clinical outcomes including GCS score Dvalue,time of hospitalization,6-month neurological disability rate and mRS score,CSF-TP D-value,CSF-LDH D-value,Lym D-value,CK-MB D-value,LDH D-value,NSE D-value,improvement rate of EEG and MRI(P>0.05).Univariate and multivariate logistic regression analyses[OR=1.185,95%CI(1.026~1.369),P=0.021]indicated that the delay of the onset of mild therapeutic hypothermia treatment was an independent risk factor for neurological disability in children with IAE after mild therapeutic hypothermia treatment of 6 months.Conclusion There was no significant difference in the clinical outcomes between 33℃and 35℃mild therapeutic hypothermia for children with IAE.Therefore,mild therapeutic hypothermia for children with IAE may not require a strict requiremen

关 键 词：亚低温治疗 流感 脑病 脑炎 危险因素 

分 类 号：R742.9[医药卫生—神经病学与精神病学]