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目的 探讨暴发型流行性脑脊髓膜炎早期诊断和免疫调节剂治疗效果。方法 对 2 0 0 0～ 2 0 0 2年北京儿童医院收治的 2 1例暴发型流行性脑脊髓膜炎患儿进行详细的临床观察 ,找出早期的临床表现 ,并且对其中 6例患儿在常规治疗基础上联用静脉注射免疫球蛋白 (IVIG)和甲基泼尼松龙 (免疫治疗组 ) ,与同期 5例单纯用常规治疗的患儿 (对照组 )进行对照 ,观察休克纠正时间及病死率。结果 (1)早期表现 :暴发型流行性脑脊髓膜炎早期可以以呼吸道或消化道感染起病 ,同时伴有重症感染中毒症状 ,皮肤淤点出现晚。 (2 )免疫治疗组与对照组比较 :神志转清、四肢末稍循环改善、血压恢复、休克纠正、脏器低灌注时间及病死率均有明显改善。结论 暴发型流行性脑脊髓膜炎早期多以重症感染征象为特点。应用IVIG及甲基泼尼松龙治疗可调节感染性休克患儿的免疫机制并改善预后。
Objective To investigate the early diagnosis and treatment of fulminant epidemic meningitis. Methods A total of 21 children with fulminant episodes of epidemic meningitis in Beijing Children’s Hospital from 2000 to 2002 were investigated in detail and their clinical manifestations were identified. Six of them On the basis of conventional treatment, intravenous immunoglobulin (IVIG) and methylprednisolone (immunotherapy group) were used in combination with 5 patients (control group) who were treated with conventional therapy alone during the same period to observe the time of shock correction And fatality rate. Results (1) Early manifestation: In the early stage of fulminant cerebrospinal meningitis, the onset of respiratory or digestive tract infection may be accompanied with the symptoms of severe infection and the onset of skin petechia. (2) Immunotherapy group compared with the control group: consciousness to clear, the end of the limbs slightly improved circulation, blood pressure recovery, shock correction, organ perfusion time and mortality were significantly improved. Conclusion In the early stage of fulminant epidemic cerebrospinal meningitis, most were characterized by severe infection signs. The application of IVIG and methylprednisolone can regulate the immune mechanism and improve the prognosis of children with septic shock.