小儿热性惊厥预后影响因素分析

目的分析小儿热性惊厥复发、转为癫痫、出现脑损伤的影响因素。方法根据169例热性惊厥患儿初发年龄、缺铁性贫血、发作时体温、惊厥分型、持续时间、围产期异常、脑电图、惊厥家族史等临床资料及随访情况,对复发、转为癫痫、出现脑损伤的影响因素分别进行单因素分析和Logistic回归分析。结果复发的危险因素有：初发年龄〈1岁、SFC、惊厥家族史;转为癫痫的危险因素有：惊厥≥2次、持续≥15min、SFC;出现脑损伤的的危险因素有：持续≥15min、SFC。结论对热性惊厥患儿应密切随访,采取积极的防治措施。     

癫癎患儿神经元特异性烯醇化酶、生长抑素和一氧化氮的检测及意义

目的:探讨癫癎(epilepsv,EP)患儿血清和脑脊液(cerebrospinal fhuid,CSF)神经元特异性烯醇化酶(neuron-specific enolase,NSE)、生长抑素(somatostatin,SS)和一氧化氮(nitric oxide,NO)的含量及其与EP的发病机制、脑损伤的关系.方法:分别采用电化学发光法、反射免疫法、硝酸还原酶法测定EP患儿癫痫发作后24h内血清和CSF NSE、SS和NO的含量.结果:EP患儿血清和CSF NSE水平均明显高于对照组(P＜0.05);而严重组血清和CSF NSE水平也明显高于普通组(P＜0.05).EP患儿CSFSS水平明显高于对照组(P＜0.05),NO水平明显低于对照组(P＜0.05);而血清NO水平明显高于对照组(P＜0.05).结论:EP发作可引起血清和CSF NSE水平升高,可导致神经元损伤;SS可能具有致EP作用;NO可能有抗EP作用.     

儿童惊厥脑脊液和血清中NSE的变化及其临床意义

目的:探讨小儿惊厥发作时间,引起惊厥原因对脑神经元的损伤及其程度.方法:按照引起小儿惊厥的病因及惊厥发生持续的时间及次数进行分组.应用酶联免疫法和分光光度法测定惊厥发作后不同时间患儿脑脊液和血清中神经元特异烯醇化酶(Neuron-specific eno-lase,NSE)的含量.结果:除热性惊厥组外,所有惊厥患儿脑脊...     

血清神经元特异性烯醇化酶与儿童失神癫■关系的研究

目的:探讨血清神经元特异性烯醇化酶(NSE)在失神癫■儿童癫■发作后水平的变化及其与脑损伤的关系?方法:选择失神癫■儿童22例,根据过度换气是否能诱发失神癫■发作分为2个亚组:失神发作组10例,失神非发作组12例;正常对照组20例?应用酶联免疫法(ELISA)测定各组血清NSE水平?结果:失神发作组癫■发作后30 min内,血清NSE水平显著高于失神非发作组及正常对照组,差异有统计学意义(P < 0.01);而失神非发作组与正常对照组相比,差异无统计学意义(P > 0.05)?结论:失神癫■发作后血清NSE水平明显升高,提示失神癫■发作后存在一定程度的脑神经元损伤,NSE可作为早期检测失神癫痫发作后神经元损伤的一个重要特异性生化指标?     

An aphasic syndrome in children

The paper presents case reports of nine children, all of whom had severe disturbances of language function of abrupt or gradual onset. Seizures occurred in seven of the children and all nine had EEG abnormalities.

There was no apparent correlation between the seizures, the EEG changes and the aphasia. One patient had a brain biopsy performed at another hospital and the tissue was said to be normal. The cause of the abnormal language function is unknown. Five of the children failed to acquire normal speech subsequently. Three of the four children who made a complete recovery were treated with steroids.

     

Cerebrospinal fluid/serum lactic acid in febrile convulsions

Cerebrospinal fluid/serum lactic acid was prospectively assayed in 42 patients with febrile convulsions. Patients were divided into two groups for analytical purposes. Those with brief febrile seizures (30 patients) and the remaining 12 patients had prolonged febrile seizures. CSF and serum lactic acid values were within normal range in patients with brief seizures while elevated values were obtained in patients with prolonged seizures. The mean CSF lactic acid on admission was significantly higher (P less than 0.001) in patients with prolonged seizures than corresponding values in those with brief seizures. Mean serum lactic acid on admission was also significantly higher in patients with prolonged febrile seizures compared to the corresponding mean value in patients with brief seizures (P greater than 0.001). Patients who recovered with neurological deficits had significantly higher CSF lactic acid on admission (P greater than 0.001). Similarly 8 patients who had recurrent febrile convulsions had significantly higher CSF lactate on admission. It is suggested that measurement of CSF lactate can be used as a biochemical marker to identify children with prolonged seizures and those who are likely to have recurrent febrile seizures.     

S100B蛋白在癫痫患儿血清中的表达及其临床意义

目的探讨SIOOB蛋白在癫痫患儿血清中的表达及其临床意义。方法选择绍兴市人民医院2010年2月1013年3月收治的癫痫患儿208例作为病例组,其中全身性发作（GSEP）87例,部分性发作（FSEP）121例。同期体检健康儿童135例作为对照组,采用酶联免疫吸附法（ELISA）检测正常儿童及癫痫患儿发作后4h和24h血清S100B蛋白水平。结果正常儿童血清S100B蛋白呈现偏态分布,与年龄呈负相关;癫痫组患儿发作4h后血清S100B蛋白水平较正常儿显著升高（P〈0．05）,且GSEP组水平显著高于FSEP组（P〈0．05）;癫痫组患儿发作后24h血清S100B蛋白水平较发作后4h显著下降（P〈0．05）,高于正常儿童,但差别无统计学意义（P〉0．05）,GSEP组与FSEP组问差别亦无统计学意义（P〉0．05）。结论癫痫发作早期脑损伤明显,严重程度与发作类型密切相关,但恢复较快。血清S100B可作为判断癫痫患儿神经损伤程度的敏感指标。     

苯巴比妥钠在预防复发性小儿热性惊厥57例中的疗效评价

目的:探讨对有小儿热性惊厥史的发热患儿,应用扑热息痛降温的同时口服小剂量苯巴比妥钠,进行预防复发性小儿热性惊厥的临床疗效评价。方法:将患儿分为治疗组(57例)和对照组(51例),治疗组对有热性惊厥史的患儿在发热时,除口服扑热息痛降温及常规抗炎治疗外,无论是否发生惊厥,均予苯巴比妥钠片口服预防惊厥,体温正常时不再继续服用苯巴比妥钠。对照组除在发生惊厥时应用镇静剂外,不再使用任何镇静药物预防。结果:治疗组仅3例发生惊厥,复发率为5.2%,对照组有20例再次发生惊厥,复发率为39.3%。两组比较有显著性差异(P<0.01)。结论:针对有小儿热性惊厥史和热性惊厥好发年龄段的发热患儿,进行扑热息痛降温的同时口服小剂量苯巴比妥钠,预防小儿热性惊厥发生是安全有效的。     

热性惊厥患儿烯醇化酶与脑电图检查的临床研究

目的测定热性惊厥(FS)患儿血清中神经元特异性烯醇化酶(NSE)水平与脑电图(EEG)变化,观察NSE与脑损伤的关系,以便指导临床治疗和改善预后。方法选择FS组患儿208例,其中单纯性热性惊厥(SFS)166例,复杂性热性惊厥(CFS)42例,对照组为112名同期我院健康查体儿童。FS组患儿于惊厥发作后24 h内抽取静脉血采用电化学发光法检测血清NSE,对照组标本留取及处理方法相同。FS组患儿分别于发病后第1天和第14天进行EEG检查。结果 FS组患儿血清中NSE水平明显高于健康对照组(P<0.01);CFS组与健康对照组和SFS组比较差异均具有统计学意义(P<0.01)。FS组患儿惊厥发作后第1天EEG异常率为79.8%,其中SFS组78.3%,CFS组85.7%,差异无统计学意义(P>0.05);第14天EEG异常率为24.0%,SFS组仅16.3%,CFS组则54.8%,2组比较差异具有统计学意义(P<0.01)。结论 FS后及时测定血清NSE水平,并结合EEG检查对判断脑损伤程度及预后具有重要价值。     

癫痫患儿血清及脑脊液中神经元特异性烯醇化酶变化的研究

目的探讨癫痫患儿血清和脑脊液中神经元特异性烯醇化酶(NSE)浓度的变化。方法采用酶联免疫双抗法测定EP、GCSE、FE及VE组患儿癫痫发作后24小时内血清和脑脊液中NSE水平。结果EP、GCSE、FE及VE组患儿癫痫发作后血清和脑脊液NSE水平均明显高于对照组(P<0.01),而且GCSE及VE组要较EP及FE组患儿血清和脑脊液NSE水平也明显增高(P<0.01)。血清和脑脊液中NSE浓度之间存在着明显的相关性。结论患儿癫痫发作能够产生脑神经元的损伤,并导致血清和脑脊液中NSE浓度的增高,而且NSE浓度的变化和癫痫发作的类型及频繁程度密切相关。     

轻度胃肠炎伴婴幼儿良性惊厥38例临床分析

目的:研究轻度胃肠炎伴婴幼儿良性惊厥的病因、临床特征、治疗、预后,以提高对该病的认识和诊断、治疗水平。方法:对我院2008年至2010年收治的38例轻度胃肠炎伴婴幼儿良性惊厥患儿的临床表现、实验室检查、治疗结果及随访结果进行回顾性分析。结果:38例患儿胃肠道症状相对较轻,无或有轻度脱水,电解质基本正常,脑脊液检查正常,头颅影像学正常。年龄2-36个月,平均15.6 8.2月,惊厥发生于第1天10例(26.3%),第2天16例(42.1%),第3天6例(15.8%),第4天2例(5.3%),第5天2例(5.3%),第6天1例(2.6%),第7天1例(2.6%)。惊厥发作次数1-5次,仅发作1次25例(65.7%),发作2次7例(18.4%),发作3次3例(7.8%),发作4次2例(5.3%),发作5次1例(2.6%)。35例惊厥表现为全身性强直-阵挛发作(92%),3例有失神及局灶性发作(8%)。4例患儿发病后脑电图检查异常,经复查均恢复正常。随访38例患儿均无复发,生长发育正常。结论:轻度胃肠炎伴婴幼儿良性惊厥病因尚不十分清楚,消化道症状轻而惊厥可反复发作,发作间期精神状态较好,苯巴比妥钠仍是治疗的有效药物,首剂给药剂量10mg/kg。本病预后良好,无复发,不遗留神经系统后遗症。     

凉血通瘀方治疗急性脑出血大鼠的疗效及机理研究

【目的】观察凉血通瘀方对急性脑出血大鼠的干预作用,评价凉血通瘀方不同提取物对急性脑出血的疗效及其作用机理。【方法】12只SD大鼠等比例随机分为假手术组、模型组、水提组和醇提组。除假手术组大鼠左侧尾状核注入2μL的生理盐水外,其他组的大鼠左侧尾状核内均注入2μL(0.25 U/μL)Ⅶ型胶原酶复制大鼠急性脑出血模型,给药组每天灌胃给予不同提取方法的凉血通瘀方。观察指标包括大鼠大脑大体形态,脑组织病理检查,大鼠苏醒时间、肛温、行为学评分以及血清特异性烯醇化酶(NSE)测定。【结果】术后除假手术组外,各组大鼠均具有不同程度的右侧肢体偏瘫症状,且在第3天最为严重,凉血通瘀方醇提组和水提组对脑出血大鼠神经功能学评分具有改善作用,能加速其苏醒、降低其肛温及血清NSE水平。【结论】凉血通瘀方水提液和醇提液均对Ⅶ型胶原酶诱导的急性脑出血具有一定的改善作用。     

217例脑膜瘤术后生存质量分析

目的 分析脑膜瘤患者术后影响生存质量的因素。为全面评估手术疗效提供依据。方法 回顾分析了近10年住院行脑膜瘤切除术患者的临床资料，影像学检查，手术切除程度，组织学特征及术后转归，随访从3个月-60个月，数据经计算机统计分析。结果 217例患者共行243次开颅手术；良性183例（84.3%)。非典型性20例（9.2%)。恶性14例（6.5%)；术后22例复发(10.1%)；术前47例，术后31例癫痫发作；术后44例并发神经功能缺失，其中偏瘫34（15.7%)。5例颅内出血均在术后死亡。结论 影响生存质量的主要因素包括术前癫痫发作，肿瘤大小，位置，形状，手术切除程度，组织学特征，术后偏瘫等并发症，肿瘤复发。加强和提高止血技能；提倡“不触及脑”原则；警惕瘤周静脉重要结构可减少癫痫发作发生率；术前影像分析，术中肿瘤范围识别（多中心性，脑浸润性，骨侵蚀性）及术后病理形态的观察。动态CT扫描随访能减少肿瘤的复发及提高患者生存质量。     

肌电诱发神经肌肉电刺激改善脑卒中患者偏瘫下肢运动功能的临床研究

目的探讨肌电诱发神经肌肉电刺激改善脑卒中患者偏瘫下肢运动功能的临床疗效。方法选择60例脑卒中偏瘫患者,随机分3组,第1组为常规康复治疗组;第2组为在常规康复治疗的基础上加神经肌肉电刺激;第3组在常规康复治疗基础上加用肌电诱发的神经肌肉电刺激。测定上述患者肌肉静态及收缩时肌电值,应用简式Fugl-Meyer功能评价表评价患者下肢运动功能,在疗程开始与结束时分别予以评价和比较。结果第3组患者治疗前后的肌肉静态及收缩时肌电值、应用Fugl-Meyer评价表进行评分的分值均有显著性提高,在改善下肢运动功能上明显优于单纯康复训练和在康复训练的基础上加用神经肌肉电刺激治疗（P〈0.05）。结论肌电诱发的神经肌肉电刺激疗法是一种有效的临床康复治疗方法,可以用于偏瘫患者足下垂治疗,其疗效优于单纯常规治疗方法和神经肌肉电刺激疗法。     

Febrile seizures in young children: role of fluid intake and conservation.

Febrile seizures are a common occurrence in young children with incidence rates varying from 3-14%, depending on the geographic region. Studies have suggested that an elevated temperature is a factor in their development, though other factors may synergistically lower the seizure threshold. While it is recognized that excessive or rapid dilute fluid intake can cause seizures in young children, and in adults during strenuous physical activity, less focus has been paid to its involvement during febrile illnesses. Young children are more vulnerable to the development of febrile seizures due to their small skull size relative to brain volume. In animals, reduced serum sodium levels have been shown to lower the threshold to convulsive stimuli, while hypertonic saline has been shown to rapidly reverse these effects. Similarly vasopressin, frequently elevated during acute infections, enhances fluid retention and may also be a precipitating factor for febrile seizures. Although an elevated temperature may augment seizure risk, antipyretics have not been shown to prevent them. In fact, some may increase seizure risk through a reduction in urine output. It has long been observed that fluid retention occurs during febrile infections, followed by diuresis during convalescence. This characteristic observation led to recommendations for restricted fluid intake during acute infections dating back more than 2,000 years. Only recently has there been a return to restricted fluid intake for patients with potentially reduced free water excretion. Further studies are required to determine the role of the overall fluid balance in the etiology of childhood febrile seizures.     

不同类型热性惊厥患儿心肌酶谱的临床观察

目的探讨小儿单纯型热性惊厥（simple febrile seizures,SFS）和复杂型热性惊厥（complex febrile seizures,CFS）血清心肌酶谱的变化及临床意义。方法对269例急性上呼吸道感染致热性惊厥（febrile seizures,FS）患儿进行心肌酶谱检测,根据病情分为两组,SFS组182例,CFS组87例,对两组结果进行对比分析。结果小儿热性惊厥（FS）后心肌酶谱有不同程度的变化,CFS组血清肌酸激酶同工酶（ereatine kinase—MB,CK—MB）、肌酸激酶（creatinekinase,CK）、乳酸脱氢酶（1actate dehydrogenase,LDH）、天冬氨酸转移酶（aspartate minotransferase,AST）的阳性率均增高,但与SFS组相比,只有CK—MB的阳性率差异有统计学意义（P〈0．01）;CFS组CK—MB、CK、LDH、AST的检测值均升高,但与SFS组相比,只有CK—MB的检测值差异有统计学意义（P〈0．01）。结论FS患儿抽搐时会引起心肌受损,CFS引起心肌受损更严重：CK—MB可作为FS心肌受损早期诊断及心肌受损严重程度的重要指标;对FS患儿要尽快止惊,减轻心肌损伤,尽早发现心肌受损,及时给予保护措施。     

A case series of brain abscesses in Malawian children

We report three cases of brain abscess in children admitted to QECH in 2006. All children were HIV-uninfected. One case was associated with staphylococcal empyema, another with chronic suppurative otitis media and mastoiditis, and the third case had no identified extracranial focus of infection. These cases illustrate the difficulties of diagnosis and management of brain abscesses in the resource-poor setting where other causes of infection of the central nervous system are common. The typical clinical presentation of brain abscess of altered mental state and seizures is also characteristic of cerebral malaria and meningitis and it is likely that many cases of brain abscess in Malawian children are not diagnosed. The value of cranial CT scan, ideally with contrast, for diagnosis and management of brain abscess is highlighted by these cases.     

MRI对脑瘫患儿的诊断价值及意义

目的探讨MRI在小儿脑瘫诊断中的价值及意义。方法回顾性分析2013年5月至2015年1月于我院治疗并确诊的CP患儿25例,对其MRI影像学分类及临床分型进行总结分析;结果全部25例CP患儿经MRI检查结果正常为6例、异常为19例,总阳性率为76%。依据影像学分类将脑瘫分为,脑白质病变12例(48%)、胼胝体病变5例(20%)、软化灶3例(12%)、脑萎缩2例(8%);脑白纸病变CP患儿中6例为四肢瘫、1例为双瘫、2例为偏瘫、1例为肌张力低下型、2例为混合型;胼胝体病变5例中,3例为四肢瘫、2例为即张力低下型;基底节软化灶3例中,1例为四肢瘫、2例为偏瘫;脑萎缩2例均表现为四肢瘫。痉挛型四肢瘫、双瘫、偏瘫阳性率分别为80%、100%、80%,肌张力减低型阳性检出率为75%,混合型阳性检出率为66.6%;结论 MRI检查可以作为检查脑内病变部位和性质的的首选方法,可以确切提示脑部病变的性质、部位和范围,对小儿CP的病因分析、指导用药和判断预后均具有重要价值,适宜临床推广使用。     

Hypoxia in patients with acute hemiplegia

Sixteen patients with an early dense hemiplegia due to cerebrovascular accidents were shown to have a greater degree of hypoxia than 16 matched control patients. The patients with hemiplegia had a reflex compensatory fall in arterial carbon dioxide tensions (PaCO2) with possible reduction in cerebral blood flow. Oxygen treatment led to an increase in PaCO2 in the patients with hemiplegia, but the increase in oxygen tensions in these patients was significantly less than that in the control group, suggesting increased pulmonary shunting as the cause for the hypoxia. Oxygen treatment may improve cerebral blood flow and oxygenation and have a useful role in the early management of patients with a dense hemiplegia.     

早产儿低血糖与胎龄、体重、脑损伤关系的分析

目的探讨早产儿胎龄、体重与低血糖的关系,以及早产儿低血糖与脑损伤发生率的关系。方法对129例早产儿进行血糖监测及头颅B超检测,根据胎龄、体重、血糖分组,对其低血糖、脑损伤发生情况进行χ2检验,并比较分析。结果①胎龄<31周和31~33周早产儿比较,低血糖发生率差异无统计学意义(P>0.05);前两组均比34~36周早产儿低血糖发生率增高,差异有统计学意义(P<0.05)。②体重<1500g和1500g~1999g早产儿低血糖发生率比较差异无统计学意义(P>0.05);前两组分别与2000~2800g早产儿比较,低血糖发生率均高于后者,差异有统计学意义(P<0.05)。③低血糖组脑损伤发生率高于正常血糖组,差异有统计学意义(P<0.05)。结论胎龄<34周及体重<2000g的早产儿低血糖发生率高,低血糖可导致早产儿脑损伤发生率增高,应注重早产儿的血糖早期动态检测,及时发现、纠正低血糖,减少脑损伤发生。