儿童病毒性脑炎合并呼吸衰竭64例诊断与治疗

目的：总结儿童病毒性脑炎合并呼吸衰竭的临床特点,为早期诊断和有效治疗提供经验。方法回顾性分析2005年5月至2015年5月天津市儿童医院神经内科病房收治的64例病毒性脑炎合并呼吸衰竭患儿的临床资料。结果所有患儿均为急性起病,以发热(60例,93．7%),抽搐(50例,78．1%),意识障碍(46例,71．8%),锥体束征阳性(30例,46．8%)等为主要临床表现,多于急性期发生呼吸衰竭。中枢性呼吸衰竭56例,中枢性呼吸衰竭合并周围性呼吸衰竭6例,呼吸循环衰竭2例。46例行腰椎穿刺术,32例异常,颅内压增高者10例,白细胞数增多19例,蛋白定量升高17例,脑脊液病原学阳性10例,其中单纯疱疹病毒8例,EB病毒1例,柯萨奇病毒1例。所有患儿行头CT检查,6例异常；34例行MRI检查,29例异常。所有患儿脑电图均不正常,48例(75%)患儿首次脑电图示全导弥漫性δ活动；22例患儿治疗期间监测伴有局灶或全导痫性/样放电。5例患儿电生理检查示颈段脊髓前角损害。24例患儿并发应激性溃疡,肝损害4例,心脏损害6例,肾损害4例,肺损害1例。所有患儿均行机械通气,带机时间2~50 d。33例(51．5%)好转出院,14例死亡,放弃治疗17例。25例患儿遗留多种神经功能障碍,14例继发性癫痫患儿于门诊随诊3个月至6年,其中8例为药物难治性癫痫。结论儿童病毒性脑炎合并呼吸衰竭患儿起病急,进展快,致残率、病死率高。早期识别,及时呼吸支持,注意保护脏器功能,有助于改善预后。

Diagnosis and treatment of 64 children with viral encephalitis complicated with respiratory failure

Objective To summarize the clinical features of children with viral encephalitis accompa-nied with respiratory failure,and to improve the early diagnosis and treatment. Methods The clinical data of 64 cases with viral encephalitis combined with respiratory failure in our unit from May 2005 to May 2015 were analyzed retrospectively. Results All children were characterized by sudden onset. Among them, 60 cases (93. 7%) had fever,50 cases(78. 1%) had convulsion onset,46 cases(71. 8%) had consciousness disorders, 30 cases(46. 8%) had positive pathological signs. Most of them developed respiratory failure in acute stage. Total 56 cases occurred central respiratory failure,6 cases occurred central respiratory failure with peripheral respiratory failure,2 cases occurred respiratory and circulatory failure. Total 46 cases underwent cerebrospinal fluid examination. Routine biochemical test found 32 abnormal cases,of which 10 cases had intracranial hyper-tension and 19 cases had leukocytosis,and 17 cases had increased protein content. Ten cases were positive in cerebrospinal fluid etiology examination,including herpes simplex virus positive in 8 cases,EB virus positive in 1 case,and coxsackie virus positive in 1 case. There were 6 of 64 cases with abnormal CT scans and 29 of 34 cases with abnormal MRI. The results of EEG examination were abnormal in all patients for the first time. The EEG of 48 cases showed diffuse slow waves-δ activity. EEG examination showed generalized discharges or focal discharges during treatment in 22 cases. Five cases of electrophysiological examination showed cervical spinal cord anterior horn injury. Total 24 cases were complicated with stress ulcer,4 cases with liver damage,6 cases with heart damage,4 cases with renal damage,1 case with lung damage. All cases underwent mechanical ventilation for 2-50 days. Total 33 cases(51. 5%) improved and discharged,14 cases died during hospitaliza-tion,17 cases were given up treatment. Total 25 cases had variety of neurological dysfunctions left. Total 14 cases with epilepsy were followed up for 3 months to 6 years in our department,of which 8 cases were medical-ly intractable epilepsies. Conclusion The children with viral encephalitis complicated with respiratory failure have acute onset,rapid progress,high disability and mortality. Early diagnosis and evaluation,effective mechani-cal ventilation in time,and protecting organ function,help to improve the prognosis.