摘要
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 explore the methods for early diagnosis of fulminant epidemic cerebrospinal meningitis and therapeutical effect of immunomodulator.Methods Twenty one children with fulminant epidemic cerebrospinal meningitis were observed in order to find out the early clinical manifestations;of them,6 patients were treated with intravenous immunoglobulin and methylprednisolone in addition to routine treatment.In the same period 5 patients treated by routine treatment alone were taken as controls.Shock correcting time and incidence and mortality of multiple organ system failure were compared between the two groups.Results The early clinical symptoms of fulminant epidemic cerebrospinal meningitis presented with symptoms of respiratory tract infections and digestive tract infections,which were usually accompanied by severe infectious toxic symptoms.Cutaneous purpura was a later symptom.Compared with control group,the treatment group with immunomodulator had obvious improvement in recovery of consciousness and blood pressure,circulation of extremity end-brush,correction of shock,hypoperfusion time of organs and mortality.Conclusion The early manifestations of fulminant epidemic cerebrospinal meningitis are mainly severe infectious signs.The treatment with IVIG and methylprednisolone can regulate immune mechanism of patients with infectious shock and improve their prognosis.
出处
《中国实用儿科杂志》
CSCD
北大核心
2004年第5期291-293,共3页
Chinese Journal of Practical Pediatrics
