严重脑炎：儿科重症监护病房 10 年来的病因、治疗和结局。

Severe encephalitis: aetiology, management and outcomes over 10 years in a paediatric intensive care unit.

机构信息

Department of Paediatrics, Meyer Children's Hospital IRCCS, Florence, Italy

Royal Children's Hospital Paediatric Intensive Care Unit, Parkville, Victoria, Australia.

出版信息

Arch Dis Child. 2023 Nov;108(11):922-928. doi: 10.1136/archdischild-2023-325305. Epub 2023 Jul 24.

DOI:10.1136/archdischild-2023-325305

PMID:37487693

Abstract

OBJECTIVE

To describe the characteristics, differential diagnoses, management and outcomes of severe encephalitis in children.

DESIGN

A 10-year retrospective cohort study in children admitted to a tertiary paediatric intensive care unit (PICU) with suspected encephalitis. One to 6 months' follow-up data were compared between different categories.

PARTICIPANTS

Patients from 0 to 17 years of age with acute encephalopathy and one or more of fever, seizure, focal neurological findings, cerebrospinal fluid abnormalities, EEG/neuroimaging consistent with encephalitis.

MAIN OUTCOME MEASURES

Epidemiology, clinical features, outcomes and risk factor analysis.

RESULTS

175 children with encephalitis required intensive care unit (ICU) admission over 10 years. The median age was 4.5 months (IQR 1.6-54.8). The leading cause was enterovirus (n=49, 28%), followed by parechovirus, influenza, herpes simplex virus (HSV), human herpesvirus-6 (HHV-6), , acute-disseminated encephalomyelitis and anti-N-methyl-D-aspartate-receptor-associated encephalitis. Immune-mediated encephalitis had higher prevalence in females, older age and longer duration of encephalopathy. Mechanical ventilation was required by 74 children (42%); haemodynamic support by 28 children (16%), 3 received extracorporeal membrane oxygenation (ECMO) support. Eleven patients died (case fatality rate 6.3%): five with HHV-6, two enterovirus, two influenza, one HSV, one human-metapneumovirus. At follow-up, 34 children had mild or moderate disability, and six severe disability. In a multivariable logistic regression model, three factors were associated with severe disability or death: age <2 years old (OR 8.2, CI 1.0 to 67.2), Herpesviridae aetiology (OR 14.5, CI 1.2 to 177.3) and length of intubation (OR 1.005, CI 1.00 to 1.01).

CONCLUSIONS

Encephalitis has a varied aetiology and causes death or severe disability in 1 in every 10 children requiring intensive care.

摘要

目的

描述儿童重症脑炎的特征、鉴别诊断、治疗方法和结局。

设计

这是一项在一家三级儿科重症监护病房（PICU）接受疑似脑炎治疗的儿童中进行的为期 10 年的回顾性队列研究。对不同类别之间的 1 至 6 个月的随访数据进行了比较。

参与者

年龄在 0 至 17 岁之间，有急性脑病，并有发热、癫痫发作、局灶性神经体征、脑脊液异常、脑电图/神经影像学符合脑炎的患儿。

主要观察指标

流行病学、临床特征、结局和危险因素分析。

结果

10 年间，共有 175 例脑炎患儿需要入住重症监护病房（ICU）。中位年龄为 4.5 个月（IQR 1.6-54.8）。最常见的病因是肠道病毒（n=49，28%），其次是微小病毒 B19、流感、单纯疱疹病毒（HSV）、人类疱疹病毒-6（HHV-6）、急性播散性脑脊髓炎和抗 N-甲基-D-天冬氨酸受体相关脑炎。免疫介导性脑炎在女性、年龄较大和脑病持续时间较长的患儿中更为常见。74 名患儿（42%）需要机械通气；28 名患儿（16%）需要血流动力学支持，其中 3 名患儿接受了体外膜氧合（ECMO）支持。11 名患儿死亡（病死率 6.3%）：5 名患儿为 HHV-6 感染，2 名患儿为肠道病毒感染，2 名患儿为流感感染，1 名患儿为单纯疱疹病毒感染，1 名患儿为人偏肺病毒感染。随访时，34 名患儿有轻度或中度残疾，6 名患儿有重度残疾。在多变量逻辑回归模型中，有三个因素与严重残疾或死亡相关：年龄<2 岁（OR 8.2，CI 1.0 至 67.2）、疱疹病毒属病因（OR 14.5，CI 1.2 至 177.3）和插管时间（OR 1.005，CI 1.00 至 1.01）。