|
|
小儿急性阑尾炎伴中枢神经系统炎症单中心分析
|
Abstract:
目的：探讨急性阑尾炎伴中枢神经系统炎症的诊疗措施。方法：通过分析重庆医科大学附属儿童医院2012年6月至2023年3月诊断为急性阑尾炎伴中枢神经系统炎症的患儿以及对国内外相关文献的归纳总结。结果：10例患儿中，发病年龄范围为2小时~10岁，男女比例1:1。有7例出现腹痛症状，7例出现发热，5例出现呕吐，1例出现头痛，2例出现抽搐，4例出现神萎，2例出现烦躁不安，1例出现面瘫并跛行。其中4例为单纯性阑尾炎，1例为化脓性阑尾炎，5例为坏疽性阑尾炎。9例患儿预后良好，1例患儿出现中枢神经系统损害后遗症。结论：中枢神经系统炎症与阑尾炎严重程度并无明显关系，早期经验性使用抗生素能降低患儿的致残率及死亡率。
Objective: To investigate the diagnosis and treatment of acute appendicitis with central nervous system inflammation. Methods: Children diagnosed with acute appendicitis with central nervous system inflammation in Children’s Hospital of Chongqing Medical University from June 2012 to March 2023 were analyzed and related literature at home and abroad was summarized. Results: In 10 cases, the age of onset ranged from 2 hours to 10 years old, and the ratio of male to female was 1:1. There were 7 cases of abdominal pain, 7 cases of fever, 5 cases of vomiting, 1 case of headache, 2 cases of convulsions, 4 cases of lethargy, 2 cases of restlessness, 1 case of facial paralysis and lameness. Among them, 4 cases were simple appendicitis, 1 case was suppurative appendicitis, and 5 cases were gangrenous appendicitis. The prognosis of 9 cases was good, and 1 case had sequelae of central nervous system damage. Conclusion: There is no significant relationship between central nervous system inflammation and the severity of appendicitis. Early empirical use of antibiotics can reduce the morbidity and mortality of children.
| [1] | Téoule, P., De Laffolie, J., Rolle, U., et al. (2020) Acute Appendicitis in Childhood and Adulthood: An Everyday Clinical Challenge. Deutsches ？rzteblatt International, 117, 764-774. https://doi.org/10.3238/arztebl.2020.0764 |
| [2] | Snyder, M.G.M. and Cagle, S. (2018) Acute Appendicitis Efffcient. American Family Physician, 98, 25-33. |
| [3] | 王一心, 李革. 小儿急性阑尾炎诊断与治疗的研究进展[J]. 中国现代医生, 2023, 61(9): 96-98. |
| [4] | Almaramhy, H.H. (2017) Acute Appendicitis in Young Children Less than 5 Years: Review Article. Italian Journal of Pediatrics, 43, Article No. 15. https://doi.org/10.1186/s13052-017-0335-2 |
| [5] | 赵家华, 岑雨樱, 许晓娇, 等. 1247例中枢神经系统感染性疾病的流行病学及临床特征分析[J]. 解放军医学杂志, 2024, 49(1): 43-49. |
| [6] | Cain, M.D., Salimi, H., Diamond, M.S., et al. (2019) Mechanisms of Pathogen Invasion into the Central Nervous System. Neuron, 103, 771-783. https://doi.org/10.1016/j.neuron.2019.07.015 |
| [7] | Giovane, R.A. and Lavender, P.D. (2018) Central Nervous System Infections. Primary Care: Clinics in Office Practice, 45, 505-518. https://doi.org/10.1016/j.pop.2018.05.007 |
| [8] | Baird, D.L.H., Simillis, C., Kontovounisios, C., et al. (2017) Acute Appendicitis. BMJ, 357, j1703. https://doi.org/10.1136/bmj.j1703 |
| [9] | Fujiwara, K., Turkes, G.F., Unsal, A., et al. (2022) Predictive Value of Immature Granulocyte in the Diagnosis of Acute Complicated Appendicitis. PLOS ONE, 17, e0279316. https://doi.org/10.1371/journal.pone.0279316 |
| [10] | Ullah, S., Ali, F.S., Shi, M., et al. (2022) Is It Time for Global Adoption of Endoscopic Retrograde Appendicitis Therapy of Acute Appendicitis? Clinics and Research in Hepatology and Gastroenterology, 46, Article ID: 102049. https://doi.org/10.1016/j.clinre.2022.102049 |
| [11] | Perez, K.S. and Allen, S.R. (2018) Complicated Appendicitis and Considerations for Interval Appendectomy. Journal of the American Academy of Physician Assistants, 31, 35-41. https://doi.org/10.1097/01.JAA.0000544304.30954.40 |
| [12] | D’souza, N., Hicks, G., Beable, R., et al. (2021) Magnetic Resonance Imaging (MRI) for Diagnosis of Acute Appendicitis. Cochrane Database of Systematic Reviews, 12, CD012028. https://doi.org/10.1002/14651858.CD012028.pub2 |
| [13] | Salminen, P., Tuominen, R., Paajanen, H., et al. (2018) Five-Year Follow-Up of Antibiotic Therapy for Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial. JAMA, 320, 1259-1265. https://doi.org/10.1001/jama.2018.13201 |
| [14] | Svensson, J.F., Patkova, B., Almstrom, M., et al. (2015) Nonoperative Treatment with Antibiotics versus Surgery for Acute Nonperforated Appendicitis in Children: A Pilot Randomized Controlled Trial. Annals of Surgery, 261, 67-71. https://doi.org/10.1097/SLA.0000000000000835 |
| [15] | Arredondo Montero, J., Bardají Pascual, C., Bronte Anaut, M., et al. (2022) Diagnostic Performance of Serum Interleukin-6 in Pediatric Acute Appendicitis: A Systematic Review. World Journal of Pediatrics, 18, 91-99. https://doi.org/10.1007/s12519-021-00488-z |
| [16] | Bertrand, M.M., Loubet, P., Cuvillon, P. and Prudhomme, M. (2021) Acute Appendicitis Management: Several Options. Anaesthesia Critical Care & Pain Medicine, 40, Article ID: 100798. https://doi.org/10.1016/j.accpm.2021.100798 |
| [17] | St？？, C., Nitsche, U., Neumann, P.A., et al. (2021) Acute Appendicitis: Trends in Surgical Treatment. Deutsches ？rzteblatt International, 118, 244-249. https://doi.org/10.3238/arztebl.m2021.0118 |
| [18] | Elgendy, A., Khirallah, M.G., Elsawaf, M., et al. (2023) Acute Appendicitis in Children: Is Preoperative Hyponatremia a Predictive Factor of Perforation/Gangrene? A Prospective Study. Pediatric Surgery International, 39, Article No. 281. https://doi.org/10.1007/s00383-023-05561-4 |
| [19] | 张小华. 改良内镜下逆行阑尾炎治疗术对急性阑尾炎的效果及对并发症的影响[J]. 黑龙江医药, 2024, 37(1): 174-176. |
| [20] | 郑兵, 马虎龙, 徐梦奇. 小儿急性阑尾炎并发颅内感染后VS: 1例报告[C]//全国第四届脑复苏与康复高层论坛论文集. 2014: 136-137. |
| [21] | 李叶广, 王洪琰, 张娜娜. 小儿中枢神经系统感染中C反应蛋白检测的临床价值体会[J]. 系统医学, 2023, 8(17): 164-166, 174. |
| [22] | Putz, K., Hayani, K. and Zar, F.A. (2013) Meningitis. Primary Care: Clinics in Office Practice, 40, 707-726. https://doi.org/10.1016/j.pop.2013.06.001 |
| [23] | Fellner, A., Goldstein, L., Lotan, I., et al. (2020) Meningitis Without Meningeal Irritation Signs: What Are the Alerting Clinical Markers? Journal of the Neurological Sciences, 410, Article ID: 116663. https://doi.org/10.1016/j.jns.2019.116663 |
| [24] | Neuroimmunology Group of Neurology Branch of Chinese Medical Association, Neuroimmunology Committee of Chinese Society for Immunology, Immunology Society of Chinese Stroke Association (2017) Chinese Guidelines for the Diagnosis and Management of Tumefactive Demyelinating Lesions of Central Nervous System. Chinese Medical Journal, 130, 1838-1850. https://doi.org/10.4103/0366-6999.211547 |
| [25] | Fernandez-Carbonell, C., Vargas-Lowy, D., Musallam, A., et al. (2015) Clinical and MRI Phenotype of Children with MOG Antibodies. Multiple Sclerosis Journal, 22, 174-184. https://doi.org/10.1177/1352458515587751 |
| [26] | 马静波, 华颖, 王健彪, 等. 儿童MOG抗体阳性中枢神经系统脱髓鞘病临床特征研究[J]. 中国实验诊断学, 2020, 24(10): 1606-1612. |
| [27] | Kalinowska-？yszczarz, A., Guo, Y. and Lucchinetti, C.F. (2022) Update on Pathology of Central Nervous System Inflammatory Demyelinating Diseases. Neurologia I Neurochirurgia Polska, 56, 201-209. https://doi.org/10.5603/PJNNS.a2022.0046 |
| [28] | Zhou, Q., Ni？o, D.F., Yamaguchi, Y., et al. (2021) Necrotizing Enterocolitis Induces T Lymphocyte-Mediated Injury in the Developing Mammalian Brain. Science Translational Medicine, 13, eaay6621. https://doi.org/10.1126/scitranslmed.aay6621 |
| [29] | Schreurs, R.R.C.E., Baumdick, M.E., Sagebiel, A.F., et al. (2019) Human Fetal TNF-α-Cytokine-Producing CD4 Effector Memory T Cells Promote Intestinal Development and Mediate Inflammation Early in Life. Immunity, 50, 462-476.E8. https://doi.org/10.1016/j.immuni.2018.12.010 |
| [30] | Huang, X., Hussain, B. and Chang, J. (2020) Peripheral Inflammation and Blood-Brain Barrier Disruption: Effects and Mechanisms. CNS Neuroscience & Therapeutics, 27, 36-47. https://doi.org/10.1111/cns.13569 |
