小儿重症病毒性脑炎并发脑衰竭的危险因素分析

Analysis on risk factors for child severe viral encephalitis complicating cerebral failure

目的探讨小儿重症病毒性脑炎并发脑衰竭的危险因素。方法回顾性分析2017年2月至2020年2月该院收治6个月至14岁诊断为重症病毒性脑炎且均予以呼吸机辅助通气的168例患儿的临床资料,根据有无脑衰竭分为衰竭组(n=37)和非衰竭组(n=131),分析两组临床资料重症病毒性脑炎并发脑衰竭发生的危险因素。结果衰竭组中年龄≤5岁、营养不良、发热持续时间>5 d、有惊厥持续状态、Glasgow评分<9分、WBC>20×10^(9)/L、低钠血症及脑电图重度异常比例高于非衰竭组(P<0.05),两组中性别、免疫功能低下、磁共振异常及糖皮质激素冲击治疗比例比较差异无统计学意义(P>0.05)。多因素非条件logistics回归分析结果显示:营养不良、发热持续时间>5 d、有惊厥持续状态、Glasgow评分<9分是重症病毒性脑炎并发脑衰竭的独立危险因素,OR值分别为2.975、4.221、4.740、5.339。结论营养、发热、惊厥、Glasgow评分与重症病毒性脑炎并发脑衰竭发生密切相关。

Objective To explore the risk factors of child severe viral encephalitis complicating cerebral failure.Methods The clinical data of 168 children patients with diagnosed severe viral encephalitis and treated by ventilator-assisted ventilation in the pediatric intensive care unit(PICU)of this hospital from February 2017 to February 2020 were analyzed retrospectively.The patients were divided into the failure group(n=37)and the non-failure group(n=131)according to whether cerebral failure existing.The risk factors of complicating cerebral failure occurrence of severe viral encephalitis in the clinical data were analyzed in the two groups.Results The proportions of the onset age≤5 years old,malnutrition,fever duration>5 d,persistent state of convulsion,Glasgow score<9 points,WBC>20×10^(9)/L,hyponatremia and severe abnormalities of electroencephalogram in the failure group were higher than that in the non-failure group(P<0.05).The gender,immunologic function,abnormalities of magnetic resonance imaging(MRI)and glucocorticoid shock therapy had no statistically significant differences between the two groups(P>0.05).The multivariate unconditional logistic regression analysis results showed that the malnutrition,fever duration>5 d,persistent state of convulsion,and the Glasgow score<9 points were the independent risk factors for complicating cerebral failure occurrence in severe viral encephalitis,the odds ratio(OR)values were 2.975,4.221,4.740 and 5.339,respectively.Conclusion Nutrition,fever,convulsion and Glasgow score are closely related to the occurrence of complicating cerebral failure in severe viral encephalitis.