儿童急性迟缓性麻痹病因与诊治分析

摘要

Objective To investigate the etiology, diagnosis and treatment of acute flaccid paralysis ( AFP ) in infants and young children. Methods Thirty cases of AFP treated in our hospital between May 2010 and August 2012 were enrolled. Myocardial enzymes, electrolytes, blood glucose and the paired fecal poliovirus isolates were examined. According to patients' condition, brain magnetic resonance imaging ( MRI), spinal MRI, cerebrospinal fluid examination, electromyography and intestinal virus antibody test were conducted. The clinical data including laboratory test results, etiology, diagnosis, treatment, and prognosis were retrospectively analyzed. Results Among the thirty cases of AFP, there are 20 cases with neurogenic lesions , 3 cases positive for neostigmine test, 3 cases with hypokalemia, 2 cases with increased creatase, 2 cases with abnormal brain MRI, 3 cases with abnormal spinal MRI, and 5 cases with albuminocytolgoic dissociation. Among the 30 cases, we found 10 cases of acute paralysis syndrome, 5 cases of Guillain - barre syndrome, 3 cases of acute myelitis, 3 cases of periodic paralysis, 3 cases of myasthenia gravis, 2 cases of acute dissemination Myeloencephalitis, 2 cases of traumatic neuritis, and 2 cases of polymyositis. 12 patients fully recovered, 3 patients clinical symptoms and 15 patients were left with movement disorders and other sequelae after etiological and semeiological treatment. Conclusion AFP can be found in a variety of diseases. Etiology - orientated comprehensive therapy often leads to promising prognosis. However, some patients may be left with movement disorders and other sequelae.%目的 探讨儿童急性迟缓性麻痹(AFP)的病因及其诊断治疗方法.方法 选取2010年5月-2012年8月我科收治的AFP患儿30例,均常规行心肌酶、电解质、血糖、双份粪便脊髓灰质炎病毒分离等检查.且根据患儿情况选择性行颅脑磁共振(MRI)、脊髓MRI、脑脊液、肌电图、肠道病毒抗体等检查.回顾性分析AFP患儿的实验室检查结果、病因诊断、治疗及预后.结果 30例AFP患儿中,肌电图提示神经源性病损20例,新斯的明实验阳性3例,血钾降低3例,心肌酶明显增高2例.颅脑MRI异常2例,脊髓MRI异常3例,脑脊液检查提示蛋白细胞分离5例.30例AFP患儿中,急性麻痹综合征10例,格林-巴利综合征5例,急性脊髓炎3例,周期性瘫痪3例,重症肌无力3例,急性播散性脑脊髓膜炎2例,外伤性神经炎2例,多发性肌炎2例.均经过积极有效对因及对症支持治疗,12例痊愈,3例临床症状缓解,15例遗留运动障碍等后遗症.结论 AFP可因不同病因和多种疾病引起,依据不同的病因给予有针对性的综合治疗,大多预后良好,但部分患儿可能遗留运动障碍等后遗症.