儿童患者超剂量应用抗生素致抗生素脑病误诊为病毒性脑炎临床分析

Clinical alysis of misdiagnosed antibiotics encephalophy caused by over dose antibiotics in children

【目的】探讨儿童患者超剂量应用抗生素致抗生素脑病的临床特点及病毒性脑炎临床鉴别。【方法】用HIS系统检索和查阅病历资料,回顾2009年1月20日-2011年6月20日某医院临床诊断为病毒性脑炎患儿504例,记录患儿临床用药史,疾病发生与演变过程,临床治疗与检查结果,分析儿童抗生素脑病临床特点及儿童病毒性脑炎的鉴别。【结果】儿童抗生素脑病与超剂量应用抗生素直接相关,临床表现为呕吐、意识障碍、抽搐、腹泻、脑膜刺激征,实验室检查、病原学检查和脑影像学检查阴性,脑脊液压力、白细胞数(>200)、降钙素原(procalcitonin,PCT)较病毒性脑炎低,两组患儿统计数据差异有统计学意义(P<0.05)。【结论】儿童超剂量应用抗生素是抗生素脑病的直接因素,严格掌握抗生素的使用指征、种类、用法用量是预防的关键;充分了解患儿抗生素应用情况结合实验室检查、病原学检查和脑组织影像学检查是鉴别病毒性脑炎的可靠依据。

[Objective] To explore antibiotics encephalopathy clinical features in pediatric patients caused by overdose antibiotic applications and with clinical differential viral encephalitis. [Methods] Using HIS system to retrieve and access to medical records,a review of a hospital clinical diagnosis from January 20,2009 to 2011 June 20 collected 504 cases of chil- dren with viral encephalitis, records the history of clinical use of drugs in children, disease, and evolution of clinical test re- suits,and analysed the children antibiotics encephalopathy clinical features and children with viral encephalitis identify. [Results] The children antibiotics encephalopathy was directly related to overdose use of antibiotics,clinical manifestations of vomiting, unconsciousness, convulsions, diarrhea, meningeal irritation, laboratory tests, pathogenic examination and brain imaging tests were negative cerebrospinal fluid pressure, white blood cell count （〉200）, procalcitonin （PCT） were lower compared with viral encephalitis. Data of the two groups of children were statistically significant differences （P〈0.05）. [Conclusions] Children overdose antibiotics encephalopathy is direct,strictly adhere to the indications for the use of antibi- otics, type and dosage are the keys to prevention; fully understand children with antibiotics combined with laboratory tests, pathogenic examination and imaging tests of the brain tissue are reliable basis for identification of viral encephalitis.