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目的评估重症病毒性脑炎(SVE)患儿的预后,探讨影响其预后的因素。方法回顾性分析2009年1月-2010年8月中国医科大学附属盛京医院儿科收治的56例SVE患儿的临床资料,并在患儿出院4个月后采用Liverpool预后评分量表评估其预后。根据预后将患儿分为治愈组和未愈组,采用SPSS 13.0软件进行数据处理,采用t检验和Binary Logistic回归检验分析2组临床资料与预后的相关性。结果 35%(19/54例)的SVE患儿死亡或留有严重神经系统后遗症,其中住院期间死亡7例(13%),随访中死亡3例(6%),留有严重后遗症9例(17%)、中度后遗症7例(13%)、轻微后遗症5例(9%)。导致SVE患儿预后不良的有统计学意义的因素有脑电图中度异常、惊厥持续状态、发热病程长、头颅MRI累及病灶超过2处或累及幕下及合并应激性高血糖(Pa<0.05),而脑脊液白细胞数、脑脊液蛋白量、偏瘫、意识障碍、合并多脏器损伤、低钾血症、低钠血症与SVE预后不良无关。结论 SVE严重威胁儿童的生存质量。伴有惊厥持续状态、应激性高血糖、发热时间长、脑电图中度异常及累及病灶超过2处或累及幕下等是影响儿童SVE预后的危险因素。
Objective To evaluate the prognosis of children with severe viral encephalitis (SVE) and to explore the factors influencing their prognosis. Methods The clinical data of 56 children with SVE admitted to Shengjing Hospital Affiliated to China Medical University from January 2009 to August 2010 were retrospectively analyzed. The prognosis was assessed by Liverpool prognostic rating scale 4 months after discharge . According to the prognosis of children were divided into cured and unhealed children, the use of SPSS 13.0 software for data processing, t test and Binary Logistic regression analysis of the two groups of clinical data and prognosis. Results Thirty-five (19/54) SVE patients died or left serious sequelae of the nervous system, including 7 (13%) died during hospitalization, 3 (6%) died during follow-up and 9 severe sequelae 17%), 7 cases of moderate sequelae (13%) and 5 cases of mild sequelae (9%). The statistically significant factors leading to poor prognosis in children with SVE were moderate abnormal EEG, persistent convulsions, longer duration of fever, more than 2 lesions involving cranial MRI or subconscious and complicated stress hyperglycemia (Pa <0.05 ), While the number of leukocytes in cerebrospinal fluid, cerebrospinal fluid protein, hemiplegia, disturbance of consciousness, combined with multiple organ injury, hypokalemia, hyponatremia and poor prognosis of SVE. Conclusion SVE seriously threatens the quality of life of children. Persistent seizures, stress hyperglycemia, prolonged fever, moderate abnormality of EEG, and involvement of more than 2 lesions or submucosal lesions were risk factors for prognosis of children with SVE.