两种药物联用对小儿病毒性脑炎患儿IL-1、TNF—α的作用机制研究

目的探讨更昔洛韦与病毒唑联合纳洛酮治疗小儿病毒性脑炎的临床疗效，为病毒性脑炎的治疗提供指导。方法将90例诊断为小儿病毒性脑炎患儿按随机数字表分为A组45例（纳洛酮＋更昔洛韦）和B组45例（纳洛酮＋病毒唑），A组给予纳络酮（0．01～0．03）mg／（kg·次），每隔8h静脉注射1次，更昔洛韦（5～10）mg／（kg·d），bid，静脉滴注；B组给予纳络酮（0．01～0．03）mg/（kg·次），每隔8h静脉注射1次，病毒唑10mg/（kg·d），bid，静脉滴注，两组疗程均为7d,疗程结束后，比较两组临床疗效、症状、体征恢复时间，预后情况，利用SPSS16．0进行统计学分析。结果A组的总有效率为94．29％，B组的总有效率为77．14％，A组的总有效率显著高于B组，差异具有统计学意义，P〈0．05；A组的头痛、惊厥、抽搐、意识障碍、脑膜刺激征改善时间及脑脊液复常时间等均较B组所用时间短，两组间差异有统计学意义，P〈0．01。结论更昔洛韦联合纳洛酮治疗小儿病毒性脑炎临床疗效确切，有效清除病毒，降低炎性细胞因子，尤其下降IL—1水平，保护神经元细胞，改善脑部神经功能，快速改善神经毒性作用导致的症状与体征，患儿预后更好，无严重不良反应．值得临床推广使用。

The observation of effect on children with viral encephalitis by different antiviral drugs combined naloxone

Objective To investigate the effect on children with viral encephalitis by different antiviral drugs combined naloxone,to provide guidance of the treatment of viral encephalitis.Methods All of 90 patients with viral encephalitis were randomly divided into A group of 45 patients(naloxone + ganciclovir)and group B 45 patients(naloxone + ribavirin),A group were given naloxone(0.01-0.03)mg/(kg·times),once intravenous injection every 8 h,ganciclovir(5-10)mg/(kg·d),bid,intravenous infusion.B group were given naloxone(0.01-0.03)mg /(kg·times),once intravenous injection every 8 h,ribavirin 10mg/(kg·d),bid,intravenous infusion,were treated for 7 d,the clinical symptoms,signs of recovery time,the prognosis were compared.Results The total effective rate of A group was 94.29%,B group was 77.14%,A group of the total effective rate was significantly higher than group B,the difference was statistically significant,P < 0.05.The headache,seizures,convulsions,disturbance of consciousness,meningeal irritation and cerebrospinal fluid to improve recovery time of A group were shorter than B group,differences between the two groups was statistically significant,P < 0.01.Conclusion The treatment combined ganciclovir with naloxone have exact effect in the treatment of children with viral encephalitis,effectively remove the virus and reduce the inflammatory cytokines and protect nerve cells and improve brain nerve function,leading to rapid improvement of neurological symptoms and toxic effects signs,and better prognosis in children,no serious adverse events,worthy of clinical use.