儿童重症脑炎中激素的疗程探索

The period of glucocorticoid treatment in children with severe encephalitis

目的探索糖皮质激素疗程长短对儿童重症脑炎预后的影响。方法笔者所在科住院治疗的重症脑炎患儿64例随机分为两组,在常规抗病毒治疗基础上,对照组给予地塞米松0.3 mg/(kg·d),静脉滴注,疗程1周骤停;治疗组地塞米松治疗1周后改为强的松2 mg/(kg·d),口服或鼻饲并视病情逐渐减量停药,总疗程6～8周。对急性期症状体征改善情况、恢复期症状等进行观察、随访并进行统计学分析。结果两组在发热、抽搐等急性期症状上无显著差异(P>0.05);对照组停用激素后病情反复9例,出现恢复期症状55例次,后遗症26例次,激素副作用发生4例次;治疗组停用激素后症状反复2例,出现恢复期症状26例次,后遗症4例次,激素副作用48例次,两两比较有显著性差异(P<0.05)。结论在重症脑炎的治疗中,较长时间的激素治疗可以减少症状体征的加重和反复,减轻恢复期症状,减少后遗症的发生。激素长期应用发生最多的副作用为食欲亢进、兴奋及肥胖,停用激素后均能恢复正常,其他副作用发生率较低。因此在重症脑炎的治疗中,激素的较长期治疗整体疗效优于短程治疗。

Objective To explore the length of glucocorticoid treatment in children with severe encephalitis. Meth- ods Depart the severe encephalitis of 64 cases randomly into two groups, each group of 32 cases. Antiviral treatment in Gen- eral, the control group to give dexamethasone 0.3 mg/（kg ·d）, intravenous infusion, course 1 week arrest; The treatment group to give dexamethasone treatment for 1 week ,later changed to prednisone 2mg/（ kg · d） oral or nasal feeding and de- creased gradually or withdrawn depending on the severity, total course of 6 -8 weeks. On symptoms and signs of improvement in the situation, convalescence symptoms, auxiliary check recovery situations, sequels and glucocorticoid side effects for observation, follow - up and statistical analysis. Results Two groups in the fever, convulsions acute symptoms was not significant differences（ P 〉 0.05 ）. the control group ： repeated 9 cases, recovery of 23 cases, sequelae of 12 cases, glucocorticoid side effects occurred in 7 cases after stopping glucocorticoid, the treatment group： repeated 2 cases, 10 cases of convalescent symptoms, the sequel to the 6 cases, 17 cases occurring steroid side effects after stopping glueoeorticoid. Compared to each other , it was significant difference （P 〈 0.05 ） o Conclusion In severe encephalitis, a long time of glucocorticoid therapy can reduce symptoms and signs of aggravation and repeated, relieve symptoms, reduce complications during the occurrence. Glucocorticoid long - term application occurs most side effects is excessive, excitement and obesity, after deactivating the glucocorticoid carl resume normal, other lower incidence of side effects. Therefore in the treatment of severe encephalitis, a long - term treatmenl of glncocorticoid is prior to the short - course treatment .