肠道病毒71型感染致重症脑干脑炎的临床特征和治疗

Clinical features and treatment of serious brainstem encephalitis caused by enterovirus 71 infection

摘要:

目的：分析肠道病毒71型（EV71）感染所致重症脑干脑炎的临床特征及治疗方法。方法：回顾性分析2008年5月至2008年12月32例EV71感染所致重症脑干脑炎的住院患儿病例资料。结果：32例中3岁以下的婴幼儿28例（88%），主要表现为持续发热（>38.5℃），频繁呕吐，四肢抖动。8例在病程3~4 d病情迅速恶化，突发心动过速、呼吸喘促、四肢末端凉等交感神经亢进征象，直至口鼻腔涌出血性泡沫痰，发生神经源性肺水肿或肺出血。给予积极降颅压，静脉点滴丙种球蛋白和甲基强的松龙抑制炎症反应，使用血管活性药物，保护心功能，限制液体入量，早期气管插管正压通气等治疗，痊愈23例，好转4例，放弃治疗2例，死亡3例。结论：EV71感染所致脑干脑炎多有突出的植物神经功能损害的临床特征，早期识别并正确处理神经源性肺水肿是救治成功的关键。［中国当代儿科杂志，2009，11（12）：967-969］

Abstract:

OBJECTIVE: To study the clinical features and treatment of serious brainstem encephalitis caused by enterovirus 71 (EV71) infection. METHODS: The clinical data of 32 hospitalized children with serious brainstem encephalitis caused by EV71 infection between May and December 2008 were retrospectively reviewed. RESULTS: The children whose age was younger than 3 years old accounted for 88% (22 cases). Fever (>38.5℃) lasting at least 3 days, frequent vomiting and limb twitch were presented as the main manifestations in the 32 children. Cyanosis, tachypnea, tachycardia and cold extremities were observed, and pulmonary edema or even pulmonary hemorrhage occurred in 8 children 3 to 4 days after the onset. The 32 children received a medical treatment: reduction of intracranial pressure with mannitol or frusemide, inhibition of inflammation reactivity with gamma globulin and methylprednisolone, and improvement of cardiac function and pulmonary edema with innotropic agents, fluid restriction and positive mechanical ventilation. CONCLUSIONS: Vegetative nerve functional disturbance is the main clinical feature of brainstem encephalitis caused by EV71 infection in children. An early identification and treatment of pulmonary edema or hemorrhage is of great importance.［Chin J Contemp Pediatr, 2009, 11 (12):967-969］