小儿病毒性脑膜炎低钠血症与脑电图、CT的变化及其临床意义

Hyponatremia of Children with Viral Meningitis Septicemia and The Change of Electroencephalogram (EEG) and CT and Its Clinical Significance

目的:分析小儿病毒性脑膜炎急性期低钠血症与脑电图、CT以及与病情的关系。方法:2002年1～7月扬州地区流行的肠道病毒性脑膜炎(主要是柯萨奇病毒B_5,少数为埃可病毒23)收治本院的76例进行临床分析,均在入院后1d内测血清电解质的浓度以及脑电图的检查,其中发病3～5d左右行脑CT检查共46例。结果:入院1d内发生电解质紊乱36％,其中低钠血症26％。惊厥或意识障碍组的低钠血症发生率高于非惊厥组。脑电图100％异常,其中中、重度异常21例中低钠血症发生率明显增加达43％。脑CT46例中有17例提示脑实质不同程度存在低密度影,占37％,脑损害的病人中有70％的患者存在低钠血症。结论:柯萨奇病毒和埃可病毒性脑膜炎早期即存在电解质紊乱,尤其是低钠血症,低钠血症的患儿发生惊厥或意识障碍的可能性较大,脑电图中、重度异常以及脑CT有脑实质损害时低钠血症发生率增加。本组病例提示低钠血症的发生可能是病毒性脑炎发生时机体的保护性病理生理反应有关,往往提示病情相对较重。柯萨奇病毒与埃可病毒引起的小儿脑膜炎预后较好,无明显后遗症。

Objective: To analyze the correlation between children' s acute viral meningitis of hyponatremia and the variation of EEG and CT and the statw of the illness. Methods: From Jan .2002 to July 2002, 76 cases of epidemic bowel viral meningitis sep-ticemia in Yangzhou region (chiefly Coxsackie virus 65, Echo virus 23 in small number) were treated and analyzed in our hospital. Within one daw of admission of the 76 cases to the hospital, the density of serum electrolyte was tested and EEG was examined, a-mong Which 46 cases flaring up after about 3 ~ 5 days were checked through CT. Results: Within one day of admission,electrolytic disorder occurred in 36% cases, among which 26% indicate Hyponatremia . It is probably related to the organic protective pathological and physiological reaction to viral meningitis septicemia. The rate of hyponatremia of the group of convulsions or clouding of consciousness is higher than the group of non - convulsions. 100% of EEG is abnormal, among which the rate of Hyponatremia of 21 serious cased increases apparently to 43% . Among 46 CT cases, 17 cases (37% ) suggest Low density shadow in brain to different degree ,70% of cerebral Lesion patients suffer from Hyponalemia . Conclusion: Electrolytic disorder exists at the early stage of Coxsackie virus and Echo viral meningitis septicemia, especially in hyponatremia . Children of hyponatremia will most probably suffer from con-vulaions or clouding of consciousness. Severe abnormality EEG and cerebral lesion in brain CT will result in the increase of hyponatremia .This group cases suggest that the occurrence of hyponatremia is probably related to the organic protective pathological and physiological reaction to viral meningitis septicemia and most often the state of the illness is relatively severe. The prognosis of children with meningitis septicemia caused by Coxsackie virus and Echo virus is fairly good and there is no obvious sequelae.