本文選題：病毒性腦炎　切入點：兒童　出處：《重慶醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 回顧性分析病毒性腦炎（Viral encephalitis，VE）兒童的臨床特點，以期指導(dǎo)臨床醫(yī)師更好地認(rèn)識不同地區(qū)的病毒性腦炎，達到滿意治療目的。 方法： 對2011年1月至2012年12月在重醫(yī)大附屬兒童醫(yī)院出院確診病毒性腦炎的589例患兒的病歷資料進行回顧性總結(jié)分析。 結(jié)果： 1.589例病毒性腦炎患兒年齡分布于7月~15歲以內(nèi)，平均5.60±3.37歲，中位數(shù)年齡5.00歲，其中男孩348人，占59.1%，女孩241人，占40.9%，男女比例1.44:1。 2.重慶地區(qū)422人，占71.6%；云貴川地區(qū)160人，占27.2%；其它地區(qū)7人，占1.2%。城鎮(zhèn)患兒269人，占45.7%；農(nóng)村患兒320人，占54.3%。 3.本組病例全年均有發(fā)病，但在7月份左右有集中趨勢（P＜0.01）。 4.最多見的臨床表現(xiàn)為發(fā)熱（78.6%）、嘔吐（68.3%）、頭痛（52.8%）、意識障礙（38.7%）、咳嗽（38.4%）和驚厥（36.0%）。 5.所有患兒均作血清學(xué)病毒IgM抗體檢測，318例（54.0%）異常，其中CV感染率最高，為58.5%，其次為HSV（32.4%）、AV（22.6%）、EBV（11.0%）、MEV（4.7%）、MV（4.1%）、RV（2.5%）、CMV（2.2%）。 6.567例做了腦脊液病毒IgM抗體檢測，143例（25.2%）異常，其中CV感染率最高，為50.3%，其次為HSV（28.7%）、AV（28.7%）、EBV（11.2%）、MEV（7.7%）、MV（4.9%）、RV（3.5%）、CMV（2.1%）。 7.本研究頭痛（60.2%VS47.0%，P＜0.05）多見于腸道病毒相關(guān)的VE（EVAE組），共濟失調(diào)（1.1%VS6.1%，P＜0.05）和腦膜刺激征（11.8%VS22.0%，，P＜0.05）多見于其他病毒相關(guān)的VE（OVAE組）。 8.269例做了頭顱CT檢查，59例（21.9%）異常；332例做了頭顱MRI檢查，102例（30.7%）異常；MRI優(yōu)于CT（P＜0.05）；565例做了腦電圖檢查，407例（72.0%）異常。 9.354例臨床治愈，230例臨床好轉(zhuǎn)，5例死亡；36例遺留不同程度后遺癥。 結(jié)論：本研究CV感染率（58.5%）最高；頭痛多見于EVAE組，而共濟失調(diào)和腦膜刺激征多見于OVAE組；血清學(xué)病毒IgM抗體檢測較腦脊液檢測陽性率高；頭顱CT和MRI有助評價病情和病灶定位，MRI優(yōu)于CT；腦電圖檢查異常率高，可用于早期診斷及監(jiān)測病情變化；所有VE患兒出院后都應(yīng)該隨訪至少6個月到1年。
[Abstract]:Objective:. The clinical characteristics of children with viral encephalitis were analyzed retrospectively in order to guide clinicians to better understand viral encephalitis in different areas and to achieve satisfactory treatment. Methods:. The medical records of 589 children with viral encephalitis were retrospectively analyzed from January 2011 to December 2012. Results:. In July, the age of children with viral encephalitis was less than 15 years (mean 5.60 鹵3.37 years). The median age was 5.00 years old. There were 348 boys (59.1%) and 241 girls (40.9%). The ratio of male to female was 1.44: 1. 2. There are 422 children in Chongqing, accounting for 71.6; 160 in Yungui River, accounting for 27.22; 7 in other areas, accounting for 1.2. 269 children in cities and towns, 45.7 percent in rural areas, 320 children in rural areas, accounting for 54.3 percent. 3. There was an annual incidence in this group, but there was a tendency of concentration in July (P < 0.01). 4. The most common clinical manifestations were fever (78.6), vomiting (68.3), headache (52.8), disturbance of consciousness (38.7), cough (38.4) and convulsion (36.0). 5. all the children were tested for serological virus IgM antibody in 318 cases (54.0). The CV infection rate was the highest (58.5%), and the second was HSV 32.4% (22.6V) 11.0%. 6.567 cases were tested for cerebrospinal fluid virus (IgM) antibody and 143 cases were found to be abnormal. Among them, the infection rate of CV was the highest (50.3%), followed by 28.77.7AV (28.7AV) and 11.2mv (7.7mV3.5V). 7. In this study, VS47.0 (P < 0.05) was more common in the VE(EVAE group, the ataxia was 1.1 VS6.1 (P < 0.05) and the meningeal stimulation sign was 11.8VS22.0T (P < 0.05). 8.269 cases were examined with CT scan of the head, 59 cases (21. 9)) and 332 cases with abnormal cranial MRI.) abnormal MRI was superior to that of CT(P < 0. 05% in 565 cases. Electroencephalogram (EEG) was performed in 407 cases (72.0%). 9.354 cases were cured and 230 cases were cured. 5 cases died and 36 cases left different degree sequelae. Conclusion: the CV infection rate is the highest in this study, headache is more common in EVAE group, while ataxia and meningeal irritation sign are more common in OVAE group, the positive rate of IgM antibody detection of serological virus is higher than that of cerebrospinal fluid (CSF). Cranial CT and MRI were helpful to evaluate the state of disease and location of lesions. MRI was superior to CT.The abnormal rate of EEG examination was high and could be used for early diagnosis and monitoring of disease changes. All children with VE should be followed up for at least 6 months to 1 year after discharge from hospital.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R512.3

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