日本脑炎28例患者的预后分析

Prognosis of cases 28 with Japanese encephalitis:a multivariate analysis

目的评估日本脑炎(JE)患者预后的影响因素。方法回顾性分析2004年7月～2008年9月我院治疗的28例JE患者,评定其临床资料及6个月时预后。结果 28例JE患者6个月时随访,9名患者死亡,8名患者预后差,生活不能自理。结论呼吸衰竭、癫、深昏迷(GCS<6)、颅内压显著增高(>240mmH2O)和脑电图异常及影像学病变范围广与结局差相关(P<0.05),而呼吸衰竭、频发癫(>2次)、颅内压显著增高和深昏迷与死亡密切相关(P<0.05)。积极控制成年JE患者出现的癫发作和高颅压可能是改善预后的关键措施。

Objective To evaluate the role of various clinical,neurophysiological laboratory and radiological parameters in the prognosis of with Japanese encephalitis（JE）.Methods A retrospective study was applied.28 subjects（age≥14 years old）with serologically confirmed JE from July 2004~September 2008 were evaluated.All patients underwent a detailed neurological examination,neuroimaging scan,EEG recordings,lumbar puncture and cerebrospinal fluid analysis.After 6 months,according to the modified Rankin scores,each patient＇s outcome was defined as a poor or better recovery.Results By the end of six months,nine patients had died,eight had poor outcomes,eleven patients had better recovery who could take care of themselves.Conclusion The best set of predictors of outcome included respiratory failure,seizure,deep coma（GCS6）,raised intracranial pressure（240 mmH2O）,abnormal EEG and extensive radiological changes（P0.05）.Furthermore,respiratory failure,seizures（2）,deep coma（GCS6）and raised intracranial pressure（240 mmH2O）were positively correlated with the death（P0.05）.Therefore,it might be necessary to actively controll the seizures and raised intracranial pressure in patients with JE.