两种激素方案治疗儿童急性重型病毒性脑炎的疗效比较

Effect of two therapeutic regimens with glucocorticoid hormone on severe type of acute viral encephalitis in children

目的 :比较大剂量甲基强的松龙 (MP)冲击疗法和地塞米松 (DEM)常规疗法治疗儿童急性重型病毒性脑炎的临床疗效。方法 :儿童急性重型病毒性脑炎 6 0例随机分为 MP组和 DEM组 ,每组 30例 ,MP组用大剂量 MP冲击法 (第1～ 3天 2 0 mg/ kg·d,第 4～ 6天为 15 mg/ kg· d,第 7～ 9天用 10 mg/ kg·d,静脉给药 ;第 9天后改用强的松口服维持 ) ,DEM组用地塞米松 (0 .1～ 0 .3mg/ kg· d静脉给药 )。治疗后 ,比较两组患儿的临床症状和体征 (发热、抽搐、意识障碍和脑膜刺激征 )的恢复时间及住院天数和药物不良反应。结果 :两组比较 ,MP组症状和体征恢复正常的时程明显缩短 ,差异有显著性 (P<0 .0 5 ) ;MP组平均住院天数也较 DEM组缩短 (P<0 .0 5 ) ;两组在药物不良反应方面差异无显著性。结论 :大剂量 MP冲击疗法可迅速改善临床症状、缩短病程 ,优于 DEM疗法。

Objective:To compare the curative effect of pulse therapy of methylprednisolone (MP) with that of conventional treatment of dexamethasone (DEM) on severe type of acute viral encephalitis in children. Methods: Sixty children with severe type of acute viral encephalitis were randomly divided into 2 even groups: MP group received pulse therapy of MP (20 mg/kg·d on day 1 to 3, 15 mg/kg·d on day 4 to 6, 10 mg/kg·d on day 7 to 9, and thereafter oral taking of prednisone), and DEM group accepted intravenous injection of DEM (0.1～0.3 mg/kg·d). The coincidnece time of clinical manifestations such as fever, convulsion, conscious disturbance and meningeal irritation sign,hospital days and side effects in two groups were compared. Results: The recovery time of clinical manifestations and hospital days were significantly lower in MP group than those in DEM group (P<0.05). There was no statistical difference in side effects between two groups. Conclusion: The therapeutic effect of pulse therapy of MP is superior to that of conventional treatment of DEM on severe type of acute viral encephalitis in children.