56例病毒性脑炎临床特征及预后

目的探讨病毒性脑炎的临床特征,为其临床诊断和治疗提供帮助。方法对56例病毒性脑炎患者的临床资料进行回顾性分析。结果本组患者主要表现为头痛45例（80.4%）、发热48例（85.7%）、精神异常29例（51.8%）、意识障碍11例（19.6%）及癫痫发作12例（21.4%）。本组患者腰穿检查颅内压增高者36例（64.3%）,细胞数增多者31例（55.4%）,蛋白轻度增高者9例（16.1%）,糖和氯化物均无明显异常。49例行脑电图检查,其中40例（81.6%）可见异常脑电波。32例行头部CT检查,8例（25%）可见异常低密度灶。25例行头部MRI检查,14例（56%）可见异常信号灶。予以抗病毒及对症治疗后出院时24例（42.9%）患者临床症状基本消失,30例（53.6%）遗留有轻度精神异常、智力障碍、癫痫发作等后遗症,2例（3.6%）死亡。结论头痛、发热、精神异常、意识障碍及癫痫发作为病毒性脑炎常见临床表现;病毒性脑炎诊断主要依靠临床表现、脑脊液检查、脑电图及头部影像学,多种手段结合更加可靠;疗效较好,对临床上高度疑诊病例应及早予以抗病毒治疗及正规治疗以改善预后。

Clinical Features and Prognoses of 56 Cases of Viral Encephalitis

Objective To explore the clinical features of viral encephalitis,and to provide the evidence for clinical diagnosis and treatment. Methods The clinical data of 56 patients with viral encephalitis were retrospectively analyzed. Results Among the 56 patients,45(80.4%) had headache,48(85.7%) had fever,mental abnormality was seen in 29(51.8%) patients,11(19.6%) had altered consciousness,and epileptic seizure was seen in 12(21.4%) patients.CSF specimens were examined in all 56 patients,among them 36 patients(64.3%) had an elevated opening pressure,31(55.4%) had pleocytosis,and 9(16.1%) had slightly elevated protein level.EEG was examined in 49 patients and revealed abnormal in 40(81.6%).Computer tomography(CT) was examined in 32 patients and revealed abnormal in 8(25%).Intracranial hemorrhage was seen in 25 patients and 14(56%) were revealed abnormalities.When they were discharged,24(42.9%) patients recovered completely and 30(53.6%) left more or less neurological deficits.2(3.6%) patients died. Conclusions Viral encephalitis is characterized by headache,fever,mental abnormalities,alteration of consciousness,and epileptic seizure.Its diagnosis mainly depends on clinical performance,CSF,EEG and MRI.Early diagnosis and treatment are helpful to the prognosis of viral encephalitis.