狂犬病疫苗致急性播散性脑脊髓炎1例报告并文献复习

发布时间：2018-07-25 08:35

【摘要】：目的：探讨急性播散性脑脊髓炎的临床特点、诊治以及狂犬病疫苗与急性播散性脑脊髓炎的关联、如何预防疫苗后脑脊髓炎。方法：回顾性分析一例狂犬病疫苗致急性播散性脑脊髓炎患者的病历资料并结合文献复习。设计：病例报告并文献复习。病例：患者于入院前1月因狗咬伤注射狂犬病疫苗,于注射第4针次后第3天(入院前7天)出现头痛、肢体酸痛；入院前3天出现发热、言语不清。入院腰椎穿刺化验脑脊液提示病毒感染性改变,头颅MR平扫见左侧丘脑长T1长T2病灶。干预：给予甲基泼尼松龙、丙种球蛋白冲击治疗,辅以清除氧自由基、改善循环、营养神经、气管切开辅助呼吸及营养支持等积极对症治疗。结果：患者病情进行性加重,经积极抢救,虽脱离生命危险,仍遗留严重的神经功能缺损。结论：对于病前有疫苗接种史、临床表现为急性或亚急性发病、伴有多灶性中枢神经系统功能缺损,要高度怀疑急性播散性脑脊髓炎可能,治疗方面应该早期使用大量糖皮质激素、丙种球蛋白冲击治疗,同时积极预防并发症、促进神经功能恢复以争取改善患者预后。经查阅文献得出,接种狂犬病疫苗与急性播散性脑脊髓炎发病存在高度关联,且二者存在明显剂量反应关系,以注射第4针次后最容易发生；注射狂犬病疫苗后,成人比儿童更容易诱发急性播散性脑脊髓炎。使用WHO推荐的Zagreb免疫方案,有降低急性播散性脑脊髓炎发病的可能。
[Abstract]:Objective: to investigate the clinical features, diagnosis and treatment of acute disseminated encephalomyelitis and the relationship between rabies vaccine and acute disseminated encephalomyelitis. Methods: a case of acute disseminated encephalomyelitis caused by rabies vaccine was reviewed retrospectively. Design: case report and literature review. Case: the patient received rabies vaccine 1 month before admission due to dog bite. He developed headache and sore limbs on the third day after the 4th injection (7 days before admission). Cerebrospinal fluid (CSF) examination at admission showed the change of viral infection, and the long T 1 and T 2 lesions of left thalamus were detected on Mr plain scan. Interventions: methylprednisolone, gamma globulin shock therapy, supplemented with scavenging oxygen free radicals, improving circulation, nutritional nerve, tracheotomy, assisted respiration and nutritional support and other active symptomatic treatment. Results: the patient's condition was aggravated progressively. After active rescue, the patient was out of danger of life and left with serious nerve function defect. Conclusion: for the history of vaccination before the disease, the clinical manifestation is acute or subacute, accompanied by multiple focal central nervous system functional defects, the acute disseminated encephalomyelitis should be highly suspected. In treatment, a large number of glucocorticoids and gamma globulin should be used early, meanwhile, the complications should be prevented and the recovery of nerve function should be promoted in order to improve the prognosis of the patients. It was found that rabies vaccination was highly correlated with the onset of acute disseminated encephalomyelitis, and there was a significant dose-response relationship between the two, which was most likely to occur after injection of the fourth dose vaccine. Adults are more likely than children to induce acute disseminated encephalomyelitis. It is possible to reduce the incidence of acute disseminated encephalomyelitis using Zagreb immunization regimen recommended by WHO.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R744.53

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