Early Recognition And Intervention Of Severe EV71 Encephalitis

Objective:Retrospectively analyze the clinical features of severe EV71 encephalitis,explore the early identification indicators and effective intervention measures of severe EV71 encephalitis.Methods:Retrospectively analyze the clinical data of patients with EV71 encephalitis admitted to the Children's Hospital of Chongqing Medical University from May 2014 to May 2018.Results:1.A total of 256 cases of EV71 encephalitis were included in this study,including 182 cases in the general group and 74 cases in the severe group(including 27 deaths).2.The main onset age are?3 years old in the general group and the severe group,and the major sex are male in both groups(P>0.05).The peak seasons in the general group are from April to July and October to December,and the peak season in the severe group is from April to July.3.There was no significant difference between the general group and the severe group in persistent high fever,super high fever,myoclonus,ataxia,headache/dizziness,frequent vomiting,neck stiffness,nystagmus(P>0.05).There were statistically significant differences between the two groups in fever duration,fever peak,atypical rash,convulsion,coma,limb paralysis,dysphagia,tachycardia,hyperheart rate,high blood pressure,hypotension,polypnea,abnormal respiratory rhythm,pulmonary edema/pulmonary hemorrhage,hyperhidrosis,poor peripheral circulation perfusion(P<0.05).4.The incidence of WBC?15*10~9/L,increased neutrophil ratio,increased CRP,and stress hyperglycemia in the severe group were significantly higher than those in the general group(P<0.05).5.The analysis of death cases showed the characteristics of a high proportion of?3 years old and male dominated,and an average age of 25.93±12.85 months.The average time from onset to abnormal basic vital signs was 76.92±37.78h,the bit time from abnormal basic vital signs to death was 23.4(11.4,68.9)hours.12 cases(44%)died within 24 hours after admission.The main causes of death were respiratory failure(neurogenic pulmonary edema/pulmonary hemorrhage)or circulatory failure.6.Statistical analysis showed that IVIG combined glucocorticoid therapy was an independent protective factor for the death of severe EV71 encephalitis,and the use of ventilator was an independent risk factor.Conclusion:1.The characteristics of a high proportion of?3 years old and male dominated were found in the severe group of EV71 encephalitis,and the peak season is from April to July;It was characterized by high fever,long duration of fever and atypical appearance of rash,and it was prone to cortical involvement,brain stem and posterior group of cranial nerve involvement,autonomic nervous disorder symptoms,and peripheral nerve involvement were found in some patients.2.In the acute phase of severe EV71 encephalitis,the incidence of WBC?15*10~9/L,increased neutrophil ratio,increased CRP,and stress hyperglycemia was higher.3.Strict monitoring of basic vital signs,repeated evaluation of cardiopulmonary function,and neurological specialist evaluation can help identify severe cases early.4.Methylprednisolone combined with IVIG can help improve the rescue success rate of severe EV71 encephalitis.