大剂量纳洛酮治疗重症病毒性脑炎的疗效分析

目的探讨大剂量纳洛酮治疗重症病毒性脑炎的疗效。方法48例重症病毒性脑炎随机分成2组,治疗组21例在综合治疗基础上加用大剂量纳洛酮治疗,对照组27例仅综合治疗未加用纳洛酮。结果治疗组治愈11例(52.4%),好转8例(38.1%),对照组治愈6例(22.2%),好转13例(48.1%),两组显效(治愈和好转)率比较差异有显著性(χ2=4.70,P<0.05)。治疗组在意识转清、体温正常、抽搐停止时间及脑电图恢复正常上均优于对照组,无严重不良反应。结论大剂量纳洛酮应用于重症病毒性脑炎早期是安全有效的。     

丙种球蛋白治疗小儿重症病毒性心肌炎12例临床体会

病毒性心肌炎是一种儿科常见病。2001年3月～2004年7月我院共收治重症病毒性心肌炎患儿28例，其中12例采用丙种球蛋白静脉滴注，获得良好疗效。现报告如下。     

大剂量阿昔洛韦治疗带状疱疹病毒性脑炎的观察与护理

带状疱疹病毒性脑炎 (ＨＺＶＥ)是由水痘 带状疱疹病毒侵犯中枢神经系统 ,引起的颅内感染。我们自 1999年 5月 2 0 0 1年 10月以大剂量阿昔洛韦治疗 11例ＨＺＶＥ病人 ,效果较好。现将护理体会报告如下 :一、资料与方法 :1 临床资料 :本组病人 19例 ,随机分为两组。治疗组 (阿昔洛韦组 ) 11例 ,其中男 7例 ,女 4例 ,年龄 2 5岁～ 5 0岁 ,平均 34岁± 2 3岁。对照组 8例 ,男 5例 ,女 3例 ,年龄 2 3岁～ 5 1岁 ,平均 32岁± 2 5岁。疱疹出现前表现脑部症状者治疗组 2例 ,对照组 1例。疱疹出现后 4天～ 10天表现脑部症状者治疗组 8例 ,对照…     

病毒性脑炎35例护理体会

病毒性脑炎是由各种病毒引起的中枢神经系统感染性疾病。病情轻重不等,轻者可自行缓解,危重者可呈急进性过程,导致死亡及后遗症。其护理措施对预后非常重要,现将我科收治的35例病毒性脑炎患者的护理经验总结如下。     

丙种球蛋白对病毒性脑炎患儿免疫球蛋白、细胞因子及T细胞亚群的影响

目的观察丙种球蛋白对病毒性脑炎患儿免疫状态的影响及临床价值。方法将同期收治的60例病毒性脑炎患儿随机分为观察组和对照组各30例,两组均予抗病毒及对症治疗,在此基础上观察组加用丙种球蛋白静滴（总量2 g/kg）,疗程2周。两组治疗前后分别抽取空腹静脉血5 ml,采用免疫比浊法检测血免疫球蛋白IgA、IgE、IgG和IgM,电化学发光法检测IL-1、TNF-α水平,流式细胞术检测T细胞亚群变化。结果与治疗前及对照组比较,观察组治疗后IgG显著升高,IL-1、TNF-α水平显著降低,CD4＋水平显著升高、CD8＋水平显著下降（P均〈0.05）。结论丙种球蛋白可改善病毒性脑炎患儿的免疫状态,有可能降低病死率及致残率。     

丙种球蛋白治疗病毒性心肌炎30例临床分析

目的观察丙种球蛋白静脉注射对小儿病毒性心肌炎的疗效。方法 60例病毒性心肌炎患儿随机分成治疗组与对照组,各30例。对照组常规给予能量合剂、辅酶Q10、维生素C、维生素E等;治疗组在常规治疗基础上加用大剂量人血丙种球蛋白静脉滴注。结果应用丙种球蛋白1周后,血清IgG,IgM显著增高,IgA增高不明显,T、B淋巴细胞增生较治疗前明显提高。临床症状、心电图、心肌酶谱、平均住院日期缩短均优于对照组。结论常规治疗基础上静注丙种球蛋白能提高病毒性心肌炎治疔效果。     

甲基强的松龙早期短程冲击疗法治疗小儿重症病毒性脑炎30例临床观察

将60例患儿随机分为观察组及对照组各30例,两组均常规给予抗炎抗病毒、降颅压、止痉、退热药物,同时加强支持治疗。在此基础上观察组予甲基强的松龙短程冲击治疗,即20mg/（kg·d）静滴,1次/12h,连用3d;对照组予地塞米松1mg/（kg·d）静滴,1次/12h,连用3d。观察两组临床症状和体征恢复时间、平均住院时间和不良反应。结果观察组无1例死亡,对照组死亡3例;观察组临床症状、体征恢复及平均住院时间均明显短于对照组（P〈0.05）;观察组和对照组分别有12例和10例并发消化道出血。认为甲基强的松龙早期短程冲击疗法治疗重症病毒性脑炎安全、疗效确切。     

免疫球蛋白、阿昔洛韦联合治疗重症病毒性脑炎疗效观察

2001年2月-2004年2月，我们采川国产免疫球蛋白（IVIg）、阿昔洛韦及对症支持疗法治疗重症病毒性脑炎，在对比观察中发现疗效较好。     

静脉注射丙种球蛋白治疗病毒性脑膜炎69例

目的探讨静脉注射丙种球蛋白(IVIG)治疗病毒性脑膜炎的有效性。方法173例病毒性脑炎患儿随机分为治疗组(69例)和对照组(104例),对照组给予降颅压、对症支持治疗和病毒唑、干扰素、莪术油等常规治疗,治疗组在此基础上静脉注射IVIG(200～400mg·kg-1·d-1)3d。比较两组1周、2周治愈率及临床症状恢复时间。结果治疗组发热、头痛、呕吐、颈抵抗等恢复时间及住院日均比对照组短,差异均有非常显著性意义(P均<0.001)。两周治愈率2组差异无显著性意义,但1周的治愈率治疗组(47.8%)高于对照组(29.8%),差异有显著性意义(P<0.05)。结论静脉注射IVIG治疗病毒性脑膜炎具有促进患儿早日康复的作用。     

病毒性脑炎115例临床分析

目的探讨115例病毒性脑炎患儿的发病情况及治疗效果。方法对115例病毒脑炎病例临床资料进行总结与分析。结果本组115例病毒性脑炎患儿发病在5-7月份,经脑脊液标本常规、生化及病毒分离等检查,被确诊为病毒性脑炎。其中30例为Ⅵ型埃可病毒引起。临床表现主要为发热、头痛、呕吐、脑膜刺激征、巴氏征阳性。经住院抗病毒、降颅压、减轻脑细胞水肿及预防和纠正水、电解质紊乱等治疗,均痊愈出院,无死亡病例,平均住院为8.7天。经1-3月随访,所有患儿均智力正常,无明显后遗症。结论该组病例发病具有一定季节性、流行性,临床症状较典型,按常规病毒性脑炎治疗,愈后良好,无并发症、后遗症发生。     

Post-transfusion purpura following open heart surgery: management by high dose intravenous immunoglobulin infusion

Summary We present three cases of post-transfusion purpura (PTP) developing in the immediate post operative period after open heart surgery. All had developed platelet specific antibodies and severe anaphylactoid reactions occurred to platelet transfusion in two cases. Treatment with high dose intravenous immunoglobulin (IV IgG) led to complete recovery in two patients one of whom demonstrated a marked biphasic response pattern to therapy. The other died from congestive cardiac failure. PTP is a potentially fatal complication which may well become more frequent with increasing blood product usage.     

The viral safety of intravenous immunoglobulin

Human immunoglobulin for intravenous (IV) use has an established safety record with regard to transmission of hepatitis B virus. The bulk of available evidence also suggests that the human immunodeficiency virus (HIV) is not transmitted by IV immunoglobulin. There has been one report, however, of isolation of HIV from two patients with hypogammaglobulinaemia who had been treated with several immunoglobulin products. Certain IV immunoglobulin products have transmitted non-A, non-B (NANB) hepatitis but careful clinical assessment of recipients of other products suggests that non-infective preparations can be made. Interpretation of available data most likely to be correct is that contamination with NANB is reduced but not eliminated by cold-ethanol fractionation and that the use of further virucidal procedures in the finishing of immunoglobulin products will confer a higher degree of safety.     

Cellular changes during the infusion of high dose intravenous immunoglobulin

Summary With the ever widening group of autoimmune conditions that are beneficially affected by infusions of high dose immunoglobulin the possible mechanisms of action of such therapy appear increasingly complex. Fc mediated blockade of the mononuclear phagocyte system is an acknowledged early effect. This is, however, accompanied by a decrease of neutrophil counts which suggests that IgG binding to the neutrophil may be a mechanism of action. The decrease of neutrophil counts is transient but in immune thrombocytopenia is inversely proportional to the platelet response observed. In parallel to the effect on the neutrophil there are changes in the lymphocyte subsets with reversal of the T helper/suppressor ratio and alterations in the individual cellular constituents of each subset that correlate with the clinical response. The observed changes in B cell numbers and function suggest that T dependent and independent antibody production is effected by intravenous immunoglobulin. It is increasingly clear that in ITP at least the clinical response to IV IgG is a summation of several cellular events and their balance reflects the ultimate outcome. It may eventually be possible to use these observations to predict the likely outcome in the individual patient of this mode of therapy.Presented at the International Workshop on ITP, August 26 and 27, 1988, Lucerne, Switzerland     

The treatment of haemophilia a inhibitor with high dose intravenous immunoglobulin

Summary In patients with Haemophilia A, the development of inhibitor is a life-threatening complication of treatment. These patients are at high risk for dangerous bleeding as a result of this acquired resistance to human Factor VIII concentrate. Although treatment of bleeding complications has been improved with the introduction of an activated prothrombin complex preparation, therapy remains unsatisfactory. Two patients with Haemophilia A inhibitor were treated with high dose intravenous immunoglobulin in the expectation of an immunosuppressive effect. A rise in the antibody titre at the same time as the administration of factor VIII concentrate showed that this treatment was ineffective in patients with Haemophilia A inhibitor.     

大剂量人血丙种球蛋白冲击治疗重症传染性单核细胞增多症疗效观察

目的:观察大剂量静脉用丙种球蛋白(IVIG)治疗重症传染性单核细胞增多症(severe infectiousmononucleosis,sIM)疗效。方法:2007—2009年我院重症监护病房收治sIM患者47例,随机分为干扰素(IFN)组和IVIG组(IFN加大剂量IVIG);在治疗后第3、7及14天分别再次检测血常规、肝功能、心肌酶谱、血清铁蛋白、凝血功能等指标,并在第14天比较2组疗效。结果:治疗后第3天IVIG组已有21例(84.0%)体温降至正常,而IFN组体温无下降;除3-test、D-二聚体、CK-MB外,IVIG组在体温、血常规、AST、ALT、LDH、CK及SF的改善上与IFN组相比均差异有统计学意义(均P<0.05);治疗后第7天,IVIG组在体温稳定性、血常规、ALT、LDH及SF的恢复上与IFN组相比均差异有统计学意义(均P<0.05);治疗后第14天,IVIG组有效率88.0%,IFN组有效率63.6%,前者显效率及有效率明显好于后者(P<0.05)。结论:大剂量IVIG冲剂疗法是治疗sIM的有效方法;有部分sIM可发展为EBV-相关噬血淋巴组织增生症(EBV-HLH),应加强监测,...     

重复应用静注人免疫球蛋白对抗NMDAR脑炎认知障碍的疗效观察

目的探讨重复应用静注人免疫球蛋白对抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎患者认知障碍的疗效。 方法收集北京朝阳中西医结合急诊抢救中心神经内科自2018年12月至2021年6月诊治的以认知障碍起病的抗NMDAR脑炎患者24例,采用随机数字表法分为对照组和研究组,每组12例。对照组给予注射用甲泼尼龙琥珀酸钠联合静注人免疫球蛋白基础治疗,研究组在相同基础治疗结束2周后,重复应用静注人免疫球蛋白。观察并比较2组患者治疗前后认知障碍改善情况及不良反应发生情况。 结果研究组治疗后认知功能评分明显高于对照组,差异有统计学意义（P<0.05）。2组患者治疗期间均未出现严重不良反应,且所发生不良反应经对症治疗或治疗结束后均消失。2组患者的不良反应发生率比较,差异无统计学意义（P>0.05）。 结论重复应用静注人免疫球蛋白能显著改善抗NMDAR脑炎患者的认知障碍,且相对安全。     

病毒性脑炎近期与远期预后分析

目的比较病毒性脑炎（VE）患者近期与远期预后,并探讨影响预后的危险因素。方法收集2009年4月至2013年6月105例VE患者临床资料,依据格拉斯哥预后量表（GOS）分级,将出院时患者分为近期预后良好组（78例）,近期预后不良组（27例）,对105例研究对象排除失访后进行远期随访,分为远期预后良好组（69例）与远期预后不良组（16例）,选取14个因素进行单因素相关分析,对有统计学意义的因素进入Logistic回归分析。结果近期预后良好组有8例（12％）评为远期预后不良组,近期预后不良组有11例（58％）评为远期预后良好组。单因素分析显示发热与开始阿昔洛韦治疗时间差、脑电图、格拉斯哥昏迷量表（GCS）评分、癫痫及血清钠浓度与VE患者近期及远期预后均有关,多因素分析显示GCS评分≤8分（OR=46．431,P=0．003;OR=20．896,P=0．026）与血钠浓度〈135mmol／L（OR=8．842,P=0．004;OR=4．39,P=0．091）两个因素均为近期、远期预后的危险因素,远期预后的危险因素还包括〉3次癫痫发作（OR=12．712,P=0．001）。结论VE的预后由多因素共同作用影响,且出院时近期预后危险因素不能完全预测远期预后。GCS评分≤8分与血钠浓度〈135mmol／L是同时影响近期与远期预后的重要危险因素。     

Bichat guidelines for the clinical management of viral encephalitis and bioterrorism-related viral encephalitis

Most of the viruses involved in causing encephalitis are arthropod-borne viruses, with the exception of arenaviruses that are rodent-borne. Even if little information is available, there are indications that, most of these encephalitis-associated viruses could be used by aerosolisation during a bioterrorist attack. Viral transfer from blood to the CNS through the olfactory tract has been suggested. Another possible route of contamination is by vector-borne transmission such as infected mosquitoes or ticks. Alphaviruses are the most likely candidates for weaponisation. The clinical course of the diseases caused by these viruses is usually not specific, but differentiation is possible by using an adequate diagnostic tool. There is no effective drug therapy for the treatment of these diseases and treatment is mainly supportive, but vaccines protecting against some of these viruses do exist.     

Usefulness of various MRI sequences in the diagnosis of viral encephalitis

There is paucity of studies regarding the utility of various conventional MRI sequences in the diagnosis of viral encephalitis. The present study evaluates the usefulness of various MRI sequences in acute viral encephalitis. 88 consecutive viral encephalitis patients, aged 2-72 years were subjected to clinical evaluation. Consciousness was assessed by Glasgow Coma Scale (GCS). Serum or cerebrospinal fluid (CSF) was analyzed for dengue, Japanese encephalitis (JE), herpes, measles, echo, coxsackie and polio viruses using ELISA or PCR. Cranial MRI was done and T1, T2, FLAIR and DW images were obtained. The MRI changes were correlated with type of encephalitis and duration of illness. All the patients had altered sensorium and 37 had seizures. 22 patients had JE, 9 had dengue, 8 had herpes simplex encephalitis (HSE), 2 had Epstein-Barr virus encephalitis (EBVE) and 47 had non-specific encephalitis. The median duration of MRI study from onset was 10 days. In JE (20/22), HSE (8/8), and EBVE (2/2), MRI abnormalities were more common compared to dengue (2/9) and non-specific (20/47) encephalitis. The MRI abnormalities were more common in FLAIR (57.1%) compared to T2 (52.9%), DWI (38.1%) and T1 (19.3%) sequences. The mean ADC value in JE patients was lower (974.0 ± 110.85 ×10⁻⁶ mm²/s) than HSE (1024.33 ± 485.76 × 10⁻⁶ mm²/s). Additional MRI lesions were seen in 12.6% cases on FLAIR sequence. FLAIR and T2 sequences were more sensitive in revealing abnormalities in viral encephalitis.     

烟台地区病毒性脑炎病毒分离与病原学分析

目的了解烟台地区病毒性脑炎病原谱及其基因特征。方法采集烟台地区病毒性脑炎患者脑脊液46份及粪便标本10份,通过细胞培养分离病毒,RT-PCR扩增肠道病毒VP1区并测序,进行基因序列分析。结果从46例病毒性脑炎患者脑脊液标本中分离到11株病毒,分离率为23.91%,10份粪便标本中分离病毒5株。16株病毒经鉴定7株为肠道病毒,其中EV71型4株。EV71与其他地区流行株VP1区序列差异较小。结论烟台市病毒性脑炎以肠道病毒为主,有EV71型流行,与其他地区流行株相比,EV71型VP1区基因变异较小。