儿童重症脑炎并呼吸衰竭的临床特点及危险因素分析

SEVERE ENCEPHALITIS WITH RESPIRATORY FAILURE IN CHILDREN:CLINICAL CHARACTERISTICS AND RISK FAC-TORS

目的评价重症脑炎并发呼吸衰竭病儿的临床特点及预后,探讨发生呼吸衰竭的影响因素。方法回顾性分析2007年1月—2013年12月我科收治的66例重症脑炎病儿的临床资料,根据病儿有无呼吸衰竭将其分为未并发呼吸衰竭组和并发呼吸衰竭组,比较两组临床资料及发生呼吸衰竭的影响因素、预后。结果重症脑炎并发呼吸衰竭组较未并发呼吸衰竭组抽搐发生率高,意识障碍严重,血钠、血钙水平低,脑脊液压力高,血糖浓度高,死亡或放弃治疗比例高,两组比较差异有统计学意义（t=2.116～10.095,χ^2=20.15,P〈0.05）,而年龄、性别、起病形式、发热、头痛、病理征、血钾和脑脊液生化等因素与发生呼吸衰竭无关（P〉0.05）。结论频繁抽搐、昏迷、颅内压高、低钠血症、低钙血症、应激性高糖血症是影响重症脑炎病儿发生呼吸衰竭的危险因素。

Objective To investigate the clinical characteristics and prognosis of severe encephalitis with respiratory failure（RF）and its influencing factors in children. Methods Clinical data of 66 children with severe encephalitis,treated in our department from January 2009 to December 2010,were retrospectively reviewed.The sick kids were divided as non-respiratory failure（NRF）group and respiratory failure（RF）group according to if they were suffering from RF on admission.The clinical data,the influencing factors of RF,and prognosis were compared between the two groups. Results Compared with NRF group,the incidence of convulsions in RF group was higher,consciousness disorders severe,hyponatremia,hypocalcemia,high cerebrospinal fluid pressure,hyperglycemia,and high percentage of death or giving up treatment,the differences were significant between the two groups（t=2.116-10.095,χ^2=20.15,P〈0.05）,and age,sex,mode of onset,fever,headache,pathological signs,serum potassium and cerebrospinal fluid biochemistry had nothing to do with RF in children with severe encephalitis. Conclusion Frequent convulsions,coma,increased intracranial pressure,hyponatremia,hypocalcemia and stress hyperglycemia are risk factors for respiratory failure in children with severe encephalitis.