重症病毒性脑炎合并超难治性癫痫持续状态诊治分析

Clinical analysis of severe acute viral encephalitis combined with super- refractory status epilepticus

目的 探讨急性重症病毒性脑炎合并超难治性癫痫持续状态（SRSE）临床特点和诊治经验。方法 回顾性分析院神经内科近4年收治的重症病毒性脑炎合并SRSE患者的临床资料，随访患者病情转归。结果 男6例，女5例，年龄17-71岁。所有患者均有前驱病史，发病后0-8天出现癫痫发作。10例患者行持续床边视频脑电检测，均显示癫痫持续状态。，轻度异常10例脑脊液压力升高6例病毒检测阳性2例。头颅CT或MRI有异常信号4例表现为弥漫性脑水肿2例，额颞叶异常信号2例。9例患者行血液及脑脊液自身免疫性脑炎系列抗体检测，8例阴性，1例阳性。11例患者均接受四种或以上抗癫痫药物病程中10例患者行气管插管，其中5例行气管切开治疗。11例患者经治疗好转9例，放弃治疗1例，死亡1例。结论在VEEG监护下，灵活应用静脉麻醉剂联合足量抗癫痫药物和免疫抑制剂治疗重症病毒性脑炎合并SRSE效果好，此类患者收住神经内科ICU进行专科治疗可降低病死率。

Objective To investigate the clinical characteristics, diagnosis and treatment of severe acute viral encephalitis combined with superrefractory status epilepticus （SRSE）. Methods Retrospective analysis was performed using clinical data collected from patients who were admitted into our hospital due to severe acute viral encephalitis combined with SRSE. All the patients were follow - up visited to evaluate their prognosis. Results There were 6 men and 5 women aging from 17 to 71 years. All the patients had prodromal infection history, and presented seizures 0 to 8 days after onset. During the course of the disease, 10 patients underwent endotracheal intubation, where 5 patients required tracheotomy. According to examination tests, increased cerebrospinal fluid pressure was detected in 6 patients. Furthermore, 9 negative cases and 1 positive case were found during detection for blood and cerebrospinal fluid autoimmune encephalitis antibodies. Ten patients underwent continuous video electroencephalogram （VEEG） examination, showing severe abnormality. Meanwhile, abnormal signals of brain CT or MRI were found in 4 cases, where 2 cases showed diffuse cerebral edema and 2 cases showed frontotemporal abnormal signals. All the patients received 4 or more antiepileptic drugs in addition to two intravenous anesthetics and immunosuppressive agents. After treatment, 9 patients showed improvement, 1 patient gave up treatment, and 1 patient died. Conclusions Under VEEG monitoring, flexible use of intravenous anesthetics combined with adequate doses of antiepileptic drugs and immunosuppressive agents are effective in the treatment of severe viral encephalitis combined with SRSE, and patients who received NICU specialist treatment can reduce mortality.