纳洛酮联合阿昔洛韦治疗小儿病毒性脑炎临床研究

Clinical research of Naloxone combined with Acyclovir used for children with viral encephalitis

目的分析纳洛酮联合阿昔洛韦治疗小儿病毒性脑炎的临床疗效。方法选择2013-05—2014-08来我院治疗的80例小儿病毒性脑炎患者,按照随机数字法分为实验组和对照组各40例。2组均给予吸氧、止痉、降颅压、退热、维持水电解质平衡、控制感染等综合治疗。实验组在综合治疗基础上给予纳洛酮联合阿昔洛韦治疗。对照组仅给予阿昔洛韦治疗。观察2组患者的体征及症状恢复时间;比较2组患者血清指标;分析2组临床疗效;统计2组患者后遗症的发生状况。结果实验组患者的头痛、抽搐、惊厥、意识障碍、脑脊液恢复及脑膜刺激征等临床症状和体征的恢复时间均明显小于对照组,差异均具有统计学意义(P<0.05);治疗前,2组患者的IL-1、IL-6及TNF-2等血清指标的水平差异无统计学意义(P>0.05);治疗后,2组患者的IL-1、IL-6及TNF-ɑ等血清指标均明显降低,均较治疗前差异具有统计学意义(P<0.05),但实验组患者血清指标水平降低更为明显,较对照组差异具有统计学意义(P<0.05);治疗后,实验组总有效率95.0%,对照组总有效率70.0%,实验组总有效率显著高于对照组,差异具有统计学意义(P<0.05);经1a的随访,实验组1例出现视力障碍,1例出现癫痫后遗症,后遗症发生率5.0%;对照组13例患者发生不同程度后遗症,主要包括视力障碍、癫痫、智能迟缓等,发生率为32.5%,实验组患者后遗症发生率显著低于对照组,差异具有统计学意义(P<0.05)。结论纳洛酮联合阿昔洛韦治疗小儿病毒性脑炎,能够显著改善体征及症状,提高临床疗效,降低IL-6、IL-1及TNF-α等血清指标,明显改善后遗症的发生,是一种值得临床推广的治疗方法。

Objective To explore clinical efficacy of naloxone combined with acyclovir therapy on children with viral en- cephalitis. Methods Eighty children with viral encephalitis in our hospital from May 2013 to August 2014 were randomly di vided into experimental and control groups according to random digital table method, 40 cases in each group. Besides oxygen inhalation, antispasmodic, reducing intracranial pressure, anti-pyretic, maintaining water and electrolyte balance, infection control and other comprehensive treatment provided for all cases, patients in the experimental group received naloxone com- bined with acyclovir treatment and patients in the control group only received acyclovir treatment. In two groups, the time to symptoms and signs recovery were observed and serum markers were detected; then we comparatively analyzed the clinical ef- ficacy and adverse reactions of two groups. Results Compared with control group, experimental group had less time to the re- covery of headache, convulsions, seizures, unconsciousness, the cerebrospinal fluid values and meningeal irritati on and other clinical signs and symptoms, with significant differences （P〈0.05）. Additionally, before treatment the levels of serum IL -1, IL-6 and TNF-α of two groups showed no differences （P〉0.05）, which were significantly decreased after treatment in both two groups and displayed lower levels in experimental group relative to control group, with statistically significant differences （PM0.05）. After treatment, the total effective rate of 95.0% in the experimental group were significantly higher than 70.0% in control group （P〈0.05） ; In one-year follow-up period, one case had visual impairment and one case developed epilepsy in the experimental group with complication incidence of 5.0%, while 13 patients in control group had different degree of sequel- ae mainly including visual impairment, epilepsy, mental retardation, etc. with the incidence of 32.5 %, which showed that ex- perimental group had lower incidence relative to control group （P〈0.05）. Conclusion Naloxone combined with acyelovirtreatment can obviously improve the signs and symptoms of children with viral encephalitis, can reduce IL-6, IL-1 and TNF-α and other serum markers, and can effectively prevent the incidence of complications, thus which should be used in clinical practice.