摘要
目的 进一步探讨小儿病毒性脑炎 (病脑 )的早期诊断方法和综合治疗措施。方法 对 96例病脑患儿进行脑脊液、头颅CT和脑电图检查 ,同时测定脑脊液病毒抗体 ;对呼吸衰竭、难治性惊厥持续状态和脑水肿患儿行气管插管、CPAP给氧及鲁米那钠、氯硝安定、安定和水合氯醛、甘露醇、速尿、白蛋白、地塞米松治疗。结果 96例中 ,治愈 5 4例 (5 6 2 5 % ) ,好转 31例 (32 2 9% ) ,自动出院 9例 (9 38% ) ,死亡 2例 (2 0 8% )。结论 病脑的脑电图改变较脑脊液及颅脑CT的变化为早 ,具有早期诊断价值 ;大剂量鲁米那钠治疗难治性惊厥持续状态优于安定类药物 ,此法必须在PICU中实施 ,需机械通气呼吸支持、循环支持及心电监护仪的全面监护。中、重度脑水肿应不同剂量短间隔给甘露醇 ,甘露醇撤退时应先减量再减次数 ,总疗程不宜大于
Objective To investigate earlier diagnosis and comb ined therapy of viral encephalitis in children.Methods Routine biochemistry and cell morphology of cerebrospinal f luid of 96 cases with viral encephalitis in children were determined.The patient s were examined with computer tomography(CT) and electroencephalography(EEG).Vir al antibodies(IgG and IgM) of cerebrospinal fluid of 51 cases were measured.96 p atients were treated with tracheal cannula,continuous positive airway pressure(C PAP),phenobarbital,clonazepam,diazepam,chloral hydrate,mannitol,furosemide,album in and dexamethasone.Results Among the 96 patients,54 were cured(56 25%),31 improved(32 29%),9 auto-discharge (9 38%) and 2 died(2 08%).Conclusion Presence of EEG abnormalities is earlier than routine bi ochemistryand and cell morphology of cerebrospinal fluid and skull CT in viral e ncephalitis in children in providing earlier diagnosis.Very-high-dose phenobar bital for refractory status epilepticus in children shows better results than di azepam.The therapy requires continuous electrocardiographic monitoring,support o f circulation and mechanical ventilation in PICU.Moderate and severe cerebral ed ema is treated with mannitolby different dose and short interval.Decreass dosage before times when stopping mamitol.Courses should be less than 1 week.
出处
《中国实用儿科杂志》
CSCD
北大核心
2001年第9期540-542,共3页
Chinese Journal of Practical Pediatrics
关键词
病毒性脑炎
诊断
脑脊髓液
治疗
惊厥持续状态
脑水肿
脑电描记术
Encephalitis,viral/diagnosis Cerebrospinal fluid Th erapy Status-epilepticus Brain eedema Electroencephalography
