英国一家教学医院中成人疑似单纯疱疹病毒性脑炎的管理
Management of suspected herpes simplex virus encephalitis in adults in a U.K. teaching hospital.
作者信息
Bell David J, Suckling Ruth, Rothburn Michael M, Blanchard Tom, Stoeter David, Michael Benedict, Cooke Richard P D, Kneen Rachel, Solomon Tom
机构信息
Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool.
出版信息
Clin Med (Lond). 2009 Jun;9(3):231-5. doi: 10.7861/clinmedicine.9-3-231.
The outcome of herpes simplex virus (HSV) encephalitis is improved with prompt initiation of aciclovir treatment. Delays are common, but there is little understanding of why they occur. The case notes of 21 adults admitted with suspected HSV encephalitis over one year were reviewed. The median (range) duration of illness was 2.5 (1-99) days. Seventeen (81%) patients had a lumbar puncture (LP) performed, at a median (range) time of 24 (2-114) hours after encephalitis was suspected. Lumbar puncture was delayed for a computed tomography (CT) scan in 15 patients, but only one of these had contraindications to an immediate LP. The median (range) time from presentation to starting aciclovir was 48 (2-432) hours. HSV-PCR (polymerase chain reaction) was requested on cerebrospinal fluid from 12 patients, one of whom was positive. Five (24%) patients were given the wrong dose of aciclovir. Overall the management of suspected HSV encephalitis was often sub-optimal, with delays in LP occurring due to unnecessary CT scans, and the wrong aciclovir dose administered. Guidelines for the management of suspected encephalitis are needed.
及时开始使用阿昔洛韦治疗可改善单纯疱疹病毒（HSV）脑炎的预后。延误情况很常见，但对于其发生原因却知之甚少。回顾了21例在一年中因疑似HSV脑炎入院的成人患者的病例记录。疾病的中位（范围）病程为2.5（1 - 99）天。17例（81%）患者进行了腰椎穿刺（LP），在疑似脑炎后的中位（范围）时间为24（2 - 114）小时。15例患者因计算机断层扫描（CT）而延迟了腰椎穿刺，但其中只有1例有立即进行腰椎穿刺的禁忌证。从就诊到开始使用阿昔洛韦的中位（范围）时间为48（2 - 432）小时。对12例患者的脑脊液进行了HSV - PCR（聚合酶链反应）检测，其中1例呈阳性。5例（24%）患者阿昔洛韦剂量错误。总体而言，疑似HSV脑炎的管理往往欠佳，因不必要的CT扫描导致腰椎穿刺延迟，且阿昔洛韦剂量错误。需要制定疑似脑炎的管理指南。
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