本文關鍵詞： 病毒性腦炎 格拉斯哥預后評分 回歸分析　出處：《山西醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的：比較病毒性腦炎(viral encephalitis，VE)患者近期與遠期預后，根據(jù)臨床資料從臨床癥狀、腦電圖、腦脊液檢查、神經(jīng)影像學、治療等方面選取研究變量，并探討影響預后的危險因素。 方法：收集2010年4月至2013年6月山西醫(yī)科大學第一附屬醫(yī)院神經(jīng)內科住院治療的病毒性腦炎患者臨床資料105例，依據(jù)格拉斯哥預后量表(Glasgow outcomescale，GOS)分級，將出院時患者分為近期預后良好組(78例)，近期預后不良組(27例)；對出院半年后研究對象進行遠期隨訪，排除失訪7例，并依據(jù)以上分組標準，分為遠期預后良好組(78例)與遠期預后不良組(20例)，選取14個因素，應用SPSS13.0統(tǒng)計軟件進行單因素相關分析，對有統(tǒng)計學意義的因素進入Logistic回歸分析。 結果：近期預后良好組有9例(12%)評為遠期預后不良組，近期預后不良組有11例(50%)評為遠期預后良好組。單因素分析顯示發(fā)熱與開始阿昔洛韋治療時間差、腦電圖、格拉斯哥昏迷量表(Glasgow coma scale，GCS)評分、癲癇及血清鈉濃度與病毒性腦炎患者近期及遠期預后均有相關性(P0.05)，經(jīng)多因素Logistic回歸分析顯示GCS評分≤8分(OR=46.431，，P=0.003)與血清鈉濃度㩳135mmol/L(OR=8.842，P=0.004)為VE近期預后的危險因素，遠期預后的危險因素包括發(fā)熱與開始阿昔洛韋治療時間差≥7天(OR=7.347，P=0.010)與3次癲癇發(fā)作(OR=12.795，P=0.004)。 結論：病毒性腦炎經(jīng)過積極合理的治療，大多數(shù)患者預后良好，故臨床上對疑診病毒性腦炎的患者均應及時應用抗病毒藥物。病毒性腦炎的預后是由多因素共同作用影響，且出院時近期預后危險因素不能預測遠期預后。發(fā)熱與開始阿昔洛韋治療時間差≥7天與大于3次癲癇發(fā)作是影響遠期預后的重要危險因素。
[Abstract]:Objective: to compare the short-term and long-term prognosis of patients with viral encephalitis (VEV), and to select the study variables from clinical symptoms, electroencephalogram, cerebrospinal fluid examination, neuroimaging and treatment, and to explore the risk factors affecting the prognosis. Methods: the clinical data of 105 patients with viral encephalitis treated in Department of Neurology, first affiliated Hospital of Shanxi Medical University from April 2010 to June 2013 were collected and classified according to Glasgow outcome scale (Glasgow outescale scale). At the time of discharge, the patients were divided into two groups: 78 patients with good short-term prognosis and 27 patients with poor short-term prognosis. The study subjects were followed-up for six months after discharge, 7 cases were excluded, and according to the above grouping criteria, There were 78 patients with good long-term prognosis (n = 78) and 20 patients with poor long-term prognosis (n = 20). Fourteen factors were selected and univariate correlation analysis was carried out with SPSS13.0 statistical software. The factors with statistical significance were analyzed by Logistic regression analysis. Results: there were 9 cases with good prognosis (n = 12) and 11 cases with bad prognosis (n = 11) with a good long-term prognosis. Univariate analysis showed that the time between fever and the beginning of acyclovir treatment was different, electroencephalogram (EEG). Glasgow coma scale scale (Glasgow coma scale) score, epilepsy and serum sodium concentration were correlated with the short-term and long-term prognosis of patients with viral encephalitis (P 0.05). The multivariate Logistic regression analysis showed that the GCS score 鈮

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