脓毒性脑病的综合评估

Comprehensive Assessment of Septic Encephalopathy in Children

目的探讨小儿脓毒性脑病的临床特征及其颅脑影像学、脑血流动力学和电生理学变化特点。方法对2003年1月-2006年6月在本院PICU住院治疗的44例脓毒性脑病患儿的临床资料和颅脑CT、超声及脑电图检查结果作系统回顾性分析。按转归分为存活组与死亡组；按病因分为肺炎组、肠炎组、败血症组、阑尾穿孔组、皮肤坏疽和EB病毒感染组。应用Fisher＇s确切概率法行构成比的比较。结果1．I临床特征：44例均有意识障碍，惊厥29例，右上肢瘫痪、脑疝各1例，死亡14例。2．CT扫描检查共14例，其中多发散在低密度灶3例，弥散性低密度影伴颅内出血2例。3．超声检查共11例，其中弥散性水肿伴脑血流灌注降低5例，颅内出血1例。4．脑电图共检查10例，其中电静息3例，弥散性慢波5例，尖波、尖-慢复合波2例。5．脑电图尖波组与电静息组比较，Glasqow昏迷评分〈7分病例数差异有显著性意义（P〈0．05）。6．肺炎组与败血症组昏迷例数差异有非常显著性意义（P〈0．01）。7．存活组与死亡组比较，脑电电静息例数差异有显著性意义（P〈0．05）。结论小儿脓毒症可并发严重的脑组织结构、脑血流动力学和脑电生理学异常，尽早通过临床观察、CT扫描、超声和脑电图检查对脓毒性脑病患儿进行综合评估，以便获取更早更全面的疾病信息。

Objective To investigate the clinical features and characteristics of imaging, cerebral hemodynamics and electrophysiology of septic encephalopathy in children. Methods The clinical data and examination result of computerized tomography （ CT）, ultrasound and electroencephalogram（EEG） on encephalon of the 44 consecutive children with septic encephalopathy from Jan. 2003 to Jun. 2006 were reviewed retrospectively. According to the prognosis and the etiology, the totally 44 patients were divided into survival group, death group and pneumonia greup,enteritis greup,septicemia group,appendicular perforation group,skin gangrene group as well as EBV infection group,respectively. Fisher＇s exact test was used to compare the differences of ratio. Results 1. Clinical manifestations ：loss of consciousness was observed in all 44 cases, convulsions in 29 cases ,upper - right - limb paralysis in 1 case, cerebral hernia in 1 case, and 14 cases resulted in death. 2. Forteen cases were detected by CT scanning. Multiple local and diffuse lower density in cerebral parenchyma was observed in 3 cases and 2 cases respectively, lntraeraaial hemorrhage was found in the latter 2 cases. 3. Color doppler ultrasound was detected in 11 cases. Diffuse brain edema was found in 5 cases ,and among them intracranial hemorrhage was found in 1 case. 4. EEG was detected in 10 cases. Flat -to- isoeleetric EEG was found in 3 cases. Diffuse slow wave activities and sharp wave with sharp - slow wave complex were found in 5 cases and 2 cases , respeetively. 5. Between the sharp wave group and the fiat - to - isoelectric EEG group, the number of cases who was less than 7 with Glasgow coma scale was significant （ P 〈 0.05 ）. 6. Between the pneumoniae group and septiceamia group , the difference in the number of coma patients was very significant（P 〈0.01 ）. 7. Between those who survived and those who died, the difference in the number of patients with flat - to - isoelectric EEG was significant （ P 〈 0.05 ）. Conclusions Septic pediatric patients may result in severe abnormalities of cerebral morphology, cerebral blood flow and electrophysiology. More detailed information about septic encephalopathy in children can be obtained as early as possible by comprehensive assessment through clinical observation, CT scanning, Doppler ultrasound and EEG.