目的 探討安宮牛黃丸聯(lián)合阿昔洛韋治療兒童病毒性腦炎的臨床效果。方法 選取2016年3月—2019年5月北京懷柔醫(yī)院收治的病毒性腦炎患兒82例，隨機(jī)分成對照組（41例）和治療組（41例）。對照組靜脈滴注注射用阿昔洛韋，每次10 mg/kg，1次/8 h，每次滴注時間＞1 h。治療組在對照組基礎(chǔ)上給予安宮牛黃丸，1～3歲者，0.75 g/次；4～6歲者，1.5 g/次；7～12歲者，3 g/次；1次/d，每次將安宮牛黃丸加入15 mL生理鹽水中制成勻漿液，口服或鼻飼。兩組患兒均連續(xù)治療14 d。觀察兩組患者臨床療效，同時比較治療前后兩組患者主要癥狀和體征改善時間，外周血白細(xì)胞計數(shù)（WBC）、中性粒細(xì)胞百分率（NEUT%）值及腦脊液WBC值和腦電圖異常率，腦脊液腫瘤壞死因子-α（TNF-α）、白介素-6（IL-6）、金屬基質(zhì)蛋白酶-9（MMP-9）和神經(jīng)元特異性烯醇化酶（NSE）水平。結(jié)果 治療后，對照組臨床有效率為80.49%，顯著低于治療組的95.12%，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。治療后，治療組主要癥狀、體征的改善時間比對照組顯著縮短（P<0.05）。治療后，兩組患兒外周血WBC、NEUT%值及腦脊液WBC值和腦電圖異常率均顯著降低（P<0.05），且治療組以上常規(guī)理化指標(biāo)明顯低于對照組（P<0.05）。治療后，兩組患兒腦脊液中TNF-α、IL-6、MMP-9、NSE濃度均顯著降低（P<0.05），且治療組比對照組降低更明顯（P<0.05）。結(jié)論 安宮牛黃丸聯(lián)合阿昔洛韋治療兒童病毒性腦炎的整體療效顯著，能迅速緩解患兒發(fā)熱、抽搐等癥狀及體征，減少腦部異常放電，抑制腦組織炎癥反應(yīng)，減輕腦損傷。

Objective To investigate the clinical effect of Angong Niuhuang Pills combined with acyclovir in treatment of viral encephalitis in children. Methods Children (82 cases) with viral encephalitis in Beijing Huairou Hospital from March 2016 to May 2019 were randomly divided into control (41 cases) and treatment (41 cases) groups. Children in the control group were iv administered with Aciclovir for injection, 10 mg/kg, once every 8 h. Children in the treatment group were po administered with Angong Niuhuang Pills on the basis of the control group, 0.75 g/time for 1-3 years children, 1.5 g/time for 4-6 years children, 3 g/time for 7-12 years children, once daily. Children in two groups were treated for 14 d. After treatment, the clinical efficacy was evaluated, and the improvement time of main symptoms and signs, WBC and NEUT% value of peripheral blood, WBC value of cerebrospinal fluid, abnormal rate of EEG, TNF-α, IL-6, MMP-9 and NSE level of cerebrospinal fluid in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 80.49%, which was significantly lower than 95.12% in the treatment group, and there were differences between two groups (P<0.05). After treatment, the improvement time of main symptoms and signs in the treatment group was significantly shorter than that in the control group (P<0.05). After treatment, WBC and NEUT% value of peripheral blood, WBC value of cerebrospinal fluid, abnormal rate of EEG in two groups were significantly decreased (P<0.05), and which in the treatment group were significantly lower than those in the control group (P<0.05). After treatment, the TNF-α, IL-6, MMP-9 and NSE level of cerebrospinal fluid in two groups was significantly decreased (P<0.05), and which in the treatment group was significantly lower than that in the control group (P<0.05). Conclusion Angong Niuhuang Pills combined with acyclovir in treatment of viral encephalitis in children has a significant overall effect, can rapidly relieve the symptoms and signs such as fever and convulsion, reduce abnormal discharge in brain, inhibit inflammatory reaction in brain tissue, reduce brain injury.

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