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2023年7月 第38卷 第7期11
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儿童重症流感相关性脑病17例诊治分析

Analysis on diagnosis and treatment of 17 cases of severe influenza-associated encephalopathy of childhood

来源期刊: 广州医药 | 14-19 发布时间:2021-11-23 收稿时间:2025/11/13 18:04:31 阅读量:14
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关键词:
流行性感冒儿童脑病
InfluenzaChildrenEncephalopathy
DOI:
10.3969/j.issn.1000-8535.2021.04.004
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目的 分析重症流感相关性脑病患儿的临床特点及诊治要点。方法 回顾性分析2017年5月—2020年4月收入我院PICU的17例重症流感相关性脑病患儿的临床资料进行回顾性分析。结果 17例患儿中男性10例、女性7例,起病年龄3(2~5)岁。所有患儿均出现发热,1(0~3.5)天后出现神经系统症状,包括惊厥发作(88%)和昏迷(88%)。头颅影像学检查病变主要分布在丘脑、脑干、髓质脑室周围白质,呈对称性和多灶性改变。经颅多普勒检查出现脑血流速度减慢呈震荡波、钉子波的5例患儿均死亡。16例患儿予机械通气,2例予连续性肾替代治疗,死亡8例,存活者出院前均遗留不同程度神经系统损害。结论 儿童重症流感相关性脑病以发热、惊厥和昏迷为主要表现,头颅影像学及脑电图、经颅多普勒等检查有助于早期诊断和预后判断,早期联合应用甲强龙冲击及IVIG的有效性仍需进一步研究。
Objective To analyze the characteristics, diagnosis and treatment of severe influenza-associated encephalopathy in children. Methods The clinical data of 17 children with severe influenza-associated encephalopathy admitted to PICU from May 2017 to April 2020 were retrospectively analyzed. Results Among the 17 cases, 10 were male and 7 were female, and the onset age was 3 (2-5) years old. All children developed fever, and neurological symptoms 1 (0-3.5) days later, including seizures (88%) and coma (88%). The lesions were mainly distributed in the thalamus, brainstem and medullary ventricular white matter, showing symmetry and multifocal changes. All the 5 cases with slowed cerebral blood flow velocity and presented shock wave or nail wave died. 16 children were on mechanical ventilation, 2 with continuous renal replacement therapy, and 8 died. All the survivors had varying degrees of neurological damage before discharge. Conclusion Severe influenza-associated encephalopathy of childhood is mainly characterized by fever, convulsions and coma. Cranial imaging, EEG, TCD and other examinations are helpful for early diagnosis and prognosis judgment. The effectiveness of early combined application of methylprednisolone and IVIG still needs further study.
1、 MORICHI S, MORISHITA N, TAKESHITA M, et al. Vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) levels in the cerebrospinal fluid of children with influenza-associated encephalopathy[J]. J Infect Chemother, 2017, 23(2):80-84. MORICHI S, MORISHITA N, TAKESHITA M, et al. Vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF) levels in the cerebrospinal fluid of children with influenza-associated encephalopathy[J]. J Infect Chemother, 2017, 23(2):80-84.
2、 HASSANZADEH R A, AMINZADEH V. Acute necrotizing encephalopathy of childhood (ANEC): a case report[J]. Iran J Child Neurol, 2017, 11(1): 75-77. HASSANZADEH R A, AMINZADEH V. Acute necrotizing encephalopathy of childhood (ANEC): a case report[J]. Iran J Child Neurol, 2017, 11(1): 75-77.
3、 JHEE S S, YEN M, ERESHESKY L, et al. Low penetration of oseltamivir and its carboxylate into cerebrospinal fluid in health Japanese and Caucasian volunteers[J]. Antimicrob Agents Chemother, 2008,52(10):3687-3693. JHEE S S, YEN M, ERESHESKY L, et al. Low penetration of oseltamivir and its carboxylate into cerebrospinal fluid in health Japanese and Caucasian volunteers[J]. Antimicrob Agents Chemother, 2008,52(10):3687-3693.
4、 CáRDENAS G, SOTO-HERNáNDEZ J L, DíAZ-ALBA A, et al. Neurological events related to influenza A(H1N1) pdm09[J]. Influenza Other Respir Viruses, 2014, 8(3): 339-346. CáRDENAS G, SOTO-HERNáNDEZ J L, DíAZ-ALBA A, et al. Neurological events related to influenza A(H1N1) pdm09[J]. Influenza Other Respir Viruses, 2014, 8(3): 339-346.
5、 UCHIDE N, SUZUKI A, OHYAMA K, et al. Secretion of bioactive interleukin-6 and tumor necrosis factor-alpha protein from primary cultured human fetal membrane chorion cells infected with influenza virus[J]. Placenta,2006,27(6-7):678-690. UCHIDE N, SUZUKI A, OHYAMA K, et al. Secretion of bioactive interleukin-6 and tumor necrosis factor-alpha protein from primary cultured human fetal membrane chorion cells infected with influenza virus[J]. Placenta,2006,27(6-7):678-690.
6、 SELLERS S A, HAGAN R S, HAYDEN F G, et al. The hidden burden of influenza: a review of the extra-pulmonary complications of influenza infection[J]. Influenza Other Respi Viruses, 2017, 11(5):372-393. SELLERS S A, HAGAN R S, HAYDEN F G, et al. The hidden burden of influenza: a review of the extra-pulmonary complications of influenza infection[J]. Influenza Other Respi Viruses, 2017, 11(5):372-393.
7、 GU Y, SHIMADA T, YASUI Y, et al. National surveillance of influenza-associated encephalopathy in Japan over six years, before and during the 2009-2010 influenza pandemic[J]. PLoS One,2013,8(1): e54786. GU Y, SHIMADA T, YASUI Y, et al. National surveillance of influenza-associated encephalopathy in Japan over six years, before and during the 2009-2010 influenza pandemic[J]. PLoS One,2013,8(1): e54786.
8、 GOENKA A, MICHAEL B D, LEDGER E, et al. Neurological manifestations of influenza infection in children and adults: results of a National British Surveillance Study[J]. Clin Infect Dis,2014, 58(6):775-784. GOENKA A, MICHAEL B D, LEDGER E, et al. Neurological manifestations of influenza infection in children and adults: results of a National British Surveillance Study[J]. Clin Infect Dis,2014, 58(6):775-784.
9、 MORISHIMA T, TOGASHI T, YOKOTA S, et al. Encephalitis and encephalopathy associated with an influenza epidemic inJapan[J]. Clin Infect Dis, 2002, 35(5):512-517. MORISHIMA T, TOGASHI T, YOKOTA S, et al. Encephalitis and encephalopathy associated with an influenza epidemic inJapan[J]. Clin Infect Dis, 2002, 35(5):512-517.
10、 DADAK M, PULR, LANFERMANN H, et al. Varying patterns of CNS imaging in influenza A encephalopathy in childhood[J]. Clin Neuroradiol,2020, 30(2): 243-249. DADAK M, PULR, LANFERMANN H, et al. Varying patterns of CNS imaging in influenza A encephalopathy in childhood[J]. Clin Neuroradiol,2020, 30(2): 243-249.
11、 VOUDRIS K A, SKAARDOUTSOU A, HAROMTIS I, et al. Brain MRI findings in influenza A-associated acute necrotizing encephalopathy of childhood[J]. Eur J Paediatr Neurol,2001,5(5):199-202. VOUDRIS K A, SKAARDOUTSOU A, HAROMTIS I, et al. Brain MRI findings in influenza A-associated acute necrotizing encephalopathy of childhood[J]. Eur J Paediatr Neurol,2001,5(5):199-202.
12、 KHANDAKER G, ZURYNSKI Y, BUTTERY J, et al. Neurologic complications of influenza A(H1N1) pdm09: surveillance in 6pediatric hospitals[J].Neurology, 2012, 79(14):1474-1481. KHANDAKER G, ZURYNSKI Y, BUTTERY J, et al. Neurologic complications of influenza A(H1N1) pdm09: surveillance in 6pediatric hospitals[J].Neurology, 2012, 79(14):1474-1481.
13、 BRITTON P N, DALE R C, BLYTH C C, et al. Influenza-associated encephalitis/encephalopathy identified by the australian childhood encephalitis study 2013-2015[J]. Pediatr Infect Dis J, 2017, 36(11):1021-1026. BRITTON P N, DALE R C, BLYTH C C, et al. Influenza-associated encephalitis/encephalopathy identified by the australian childhood encephalitis study 2013-2015[J]. Pediatr Infect Dis J, 2017, 36(11):1021-1026.
14、 MIZUGUCHI M, ABE J,MIKKAICHI K, et al. Acute necrotizing encephalopathy of childhood: a new syndrome presenting with multifocal, symmetrical brain lesions[J]. J Neurol Neurosurg Psychiatry, 1995(58): 555-561. MIZUGUCHI M, ABE J,MIKKAICHI K, et al. Acute necrotizing encephalopathy of childhood: a new syndrome presenting with multifocal, symmetrical brain lesions[J]. J Neurol Neurosurg Psychiatry, 1995(58): 555-561.
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