甲基泼尼松龙与地塞米松治疗儿童急性重症病毒性脑炎的疗效比较

Effect of therapeutic regimens with methylprednisonlone and dexamethasone on severe type of acute viral encephalitis in children

目的:比较大剂量甲基泼尼松龙(MP)冲击疗法和地塞米松(DEM)常规疗法治疗儿童急性重症病毒性脑炎的临床疗效。方法:儿童急性重症病毒性脑炎120例随机分为MP组和DEM组,每组60例,MP组用大剂量MP冲击法,20mg/(kg·d),使用3～5d,后改为1～2mg/(kg·d),缓解后改为泼尼松1～2mg/(kg·d)口服,疗程共1～2个月,DEM组用地塞米松,每次0.3～0.5mg/kg,每天3～6次,3d后改为每天1～2次,共用5～7d,缓解后改为泼尼松1～2mg/(kg·d)口服,疗程共1～2个月。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,差异有统计学意义,P<0.05;MP组平均住院天数也较DEM组缩短,P<0.05;两组在药物不良反应方面相比,差异无统计学意义。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 treatment with dexamethasone（DEM）on severe type of acute viral encephalitis in children.Methods：One hundrend and twenty 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 3 to 5 days.After then 1 -2 mg/（kg .d）,and there ＇after oral taking of prednisone lasting 1 -2 months,and DEM group accepted intravenous injection of DEM 0.3-0.5 mg/kg,3-6 times a day,changed to 1-2 times a day after 3 days, and there after oral taking of prednisone lasting 1 -2 months.The coincidence 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）.Therc was no statistical difference in side effects between two groups.Conclusion：The therapeutic effect of pulse therapy of MP is superior to that of treatment of DEM on severe type of acute viral encephalitis in children.