小儿脓毒症相关性脑病的大脑MRI、EEG、动脉血流表现及临床特征

Cerebral MRI,EEG,artery blood findings,and clinical features of pediatric sepsis-associated encephalopathy

目的:探讨小儿脓毒症相关性脑病(sepsis-associated encephalopathy,SAE)的大脑磁共振成像(magnetic resonance imaging,MRI)、脑电图(electroencephalogram,EEG)、动脉血流表现及临床特征。方法:选取2016年1月至2020年3月于衡水市人民医院诊疗的396例脓毒症患儿为研究对象。根据检查结果,将合并SAE的患儿作为SAE组(n=146),将无脑病脓毒症的患儿作为非SAE组(n=250)。分析小儿SAE的临床特征、MRI影像学表现、EEG检测结果、大脑动脉血流参数及主要感染病原菌分布情况。结果:SAE组患儿发热时间、机械通气时间、住重症监护室(intensive care unit,ICU)时间均明显长于非SAE组患儿,血乳酸及28 d病死率均高于非SAE组患儿,小儿危重病评分(pediatric critical illness score,PCIS)低于非SAE组患儿,差异均有统计学意义(均P<0.05)。两组患儿MRI检测阳性率比较,差异无统计学意义(P>0.05)。SAE组EEG检测阳性率明显高于非SAE组患儿,差异有统计学意义(P<0.05)。SAE组患儿舒张末期流速(end-diastolic velocity,Vd)、平均流速(mean velocity,Vm)均明显低于非SAE组患儿,搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI)均明显高于非SAE组患儿,差异均有统计学意义(均P<0.05)。SAE组患儿革兰氏阳性菌感染率明显高于非SAE组患儿,革兰氏阳性菌中金黄色葡萄球菌感染率明显高于非SAE组患儿,差异有统计学意义(P<0.05);革兰氏阴性菌、真菌感染率比较,差异均无统计学意义(均P>0.05)。结论:SAE患儿有发热时间、机械通气时间、住ICU时间长及血乳酸水平高的特征,但SAE患儿MRI表现无特异性,需结合EEG、大脑动脉血流参数、感染菌群分布进行诊断和预后评估。

Objective:To explore the clinical features,cerebral magnetic resonance imaging(MRI),electroencephalogram(EEG),and artery blood manifestations of sepsis-associated encephalopathy(SAE)in children.Methods:A total of 396 children with sepsis who were treated in Hengshui People’s Hospital from January 2016 to March 2020 were selected as research subjects.According to the examination results,children with SAE were included in a SAE group(n=146),and children with sepsis without encephalopathy were included in a non-SAE group(n=250).The clinical features,MRI findings,EEG test results,cerebral artery blood flow parameters,and the distribution of main infectious pathogens in children with SAE were analyzed.Results:The fever time,mechanical ventilation time and intensive care unit(ICU)stay duration of the SAE group were significantly longer than those of the non-SAE group.The blood lactic acid and 28-day mortality of the SAE group were higher than those of the non-SAE group,and the pediatric critical illness score(PCIS)of the SAE group was lower than that of the non-SAE group(all P<0.05).The difference in the positive rate of MRI test between the 2 groups was not statistically significant(P>0.05).The positive rate of EEG test in the SAE group was significantly higher than that in the non-SAE group(P<0.05).The end-diastolic velocity(Vd)and mean velocity(Vm)of the SAE group were significantly lower than those of the non-SAE group,and the pulsatility index(PI)and resistance index(RI)of the SAE group were significantly higher than those of the non-SAE group(all P<0.05).The infection rate of Gram-positive bacteria in the SAE group was significantly higher than that in the non-SAE group,and the infection rate of Staphylococcus aureus among Gram-positive bacteria in the SAE group was significantly higher than that in the non-SAE group(P<0.05).There was no statistically significant difference in Gram-negative bacteria and fungal infection rate(all P>0.05).Conclusion:SAE children have the characteristics of fever time,mechanical ventilation time,long ICU stay,and high blood lactate level.However,the MRI manifestations of SAE children are not specific.It is necessary to combine EEG,cerebral artery blood flow parameters,and the distribution of infectious flora for diagnosis and prognosis.