信阳及周边地区儿童重症病毒性脑炎影响预后的多因素分析

发布时间：2018-03-31 10:27

本文选题：信阳地区　切入点：重症病毒性脑炎　出处：《郑州大学》2017年硕士论文

【摘要】：1 背景与目的儿童重症病毒性脑炎(Severe viral encephalitis,SVE)具有病情凶险、致死致残率高的特点,严重威胁儿童的生存和生活质量。其病原多样,临床表现形式多样,病原学诊断困难,预后较差。同时,SVE的流行病学特点、预后风险评估、因地域、研究方法、研究对象的不同而存在一定差异。因此,对特定地区儿童SVE临床资料的统计和分析很有必要。信阳及其周边地区地处豫南,位于中国地理分界线(秦岭—淮河)上,属亚热带向暖温带过渡区,以淮河干流河床为界,南部为北亚热带季风性湿润气候,北部为温带季风性半湿润气候,地理位置及气候独特,在病毒性脑炎的流行病学及临床表现方面或许存在地域特征。对信阳及周边地区SVE患儿临床资料的统计和分析,有助于完善该区域儿童SVE的流行病学资料,有助于区域内儿童SVE的预警和经验性治疗。信阳市中心医院儿童重症监护室是信阳及周边地区唯一一家儿童重症监护室,承担区域内SVE患儿的救治工作。为此,对影响本院SVE患儿预后的因素进行探讨,获得影响区域内儿童SVE转归的因素,以指导临床评估病情及诊疗,同时为分析区域内儿童SVE疾病的流行特征提供有益的参考。2 资料和方法收集自2014年12月至2016年11月信阳市中心医院儿科重症监护病区收治的54例SVE患儿的临床表现资料、辅助检查结果及实验室检验结果。对病例的流行病学特征进行分析,并在患儿出院时采用格拉斯哥预后量表(Glasgow Outcome Scale,GOS)评分评估其预后及残疾程度,采用队列回顾分析的方法对资料进行统计学分析,观察多种可能因素与预后的相关性,进行多因素Logistic回归分析,获得影响预后的独立危险因素。3 结果35例(64.8%)儿童SVE病例发生在7-9月,SVE发病与月平均气温及月降水量有一定关联,但并不完全平行。48例(88.9%)儿童SVE病例发病集中在乡(镇)村。计数资料中,格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分、需要机械通气、脑神经损伤和颅脑MRI异常在两组间的差异具有统计学意义(P0.05)。计量资料中,发热时长、外周血白细胞计数、CRP、CK-MB、MYO和血钾水平在两组间的差异具有统计学意义(P0.05)。GCS评分和脑神经损伤是影响预后的独立危险因素。GCS评分越低,存在脑神经损伤,预后不良的可能性越大。4 结论7-9月是信阳及其周边地区SVE的高发期,乡村发病高于城市。GCS评分和存在脑神经损伤是影响预后的独立危险因素,GCS评分越低,存在脑神经损伤,预后不良的可能性越大。
[Abstract]:Background & objective Severe viral encalitis (SVEE) has the characteristics of dangerous disease, high mortality and disability rate, which seriously threatens the survival and quality of life of children. Its etiology is difficult to diagnose, with various pathogens, various clinical manifestations and difficulties in etiological diagnosis. At the same time, the epidemiological characteristics and prognostic risk assessment of SVE are different due to different regions, research methods, and study objects. It is necessary to analyze the clinical data of children with SVE in certain areas. Xinyang and its surrounding areas are located in southern Henan Province, located on the Chinese geographical boundary (Qinling-Huaihe River), and belong to the transition zone from subtropical to warm temperate zone, with the Huaihe River main stream as the boundary. The northern subtropical monsoon humid climate is in the south and the temperate monsoon semi-humid climate in the north. The geographical location and climate are unique. There may be regional characteristics in the epidemiology and clinical manifestations of viral encephalitis. The statistics and analysis of clinical data of children with SVE in Xinyang and its surrounding areas are helpful to improve the epidemiological data of SVE in children in this area. This unit is the only child intensive care unit in and around Xinyang, which is responsible for the treatment of children with SVE in the region. The factors influencing the prognosis of children with SVE in our hospital were discussed, and the factors influencing the outcome of SVE in children were obtained to guide the clinical evaluation and diagnosis and treatment. At the same time, it provided useful reference and data for analyzing the epidemic characteristics of SVE disease in children in the region. Methods 54 cases of SVE were collected from December 2014 to November 2016 in the pediatric intensive care ward of Xinyang Central Hospital. The epidemiological characteristics of the patients were analyzed and the Glasgow Outcome scale scale (Glasgow scale) score was used to evaluate the prognosis and the degree of disability at the time of discharge. The data were statistically analyzed by cohort retrospective analysis, and the correlation between multiple possible factors and prognosis was observed, and multivariate Logistic regression analysis was performed. Results the incidence of SVE in 35 children was associated with monthly mean temperature and monthly precipitation in July and September. However, the incidence of SVE in children was mainly in the village of township (town). The Glasgow Coma scale score, which required mechanical ventilation, was not completely parallel. The difference of cerebral nerve injury and brain MRI abnormality between the two groups was statistically significant (P 0.05). There was significant difference between the two groups in the level of serum potassium and the level of CK-MBO MYO in peripheral blood leukocyte count. The lower the independent risk factor of prognosis, the lower the score of CK-MBO MYO and potassium, and the lower the score of brain nerve injury, the lower the score of GCS and the score of brain nerve injury. Conclusion the incidence of SVE in Xinyang and its surrounding areas is higher in July-September. The incidence of SVE in rural areas is higher than that in cities and the existence of brain nerve injury is an independent risk factor for prognosis. The greater the likelihood of poor prognosis.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.1

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