目的 探讨安宫牛黄丸联合阿昔洛韦治疗儿童病毒性脑炎的临床效果。方法 选取2016年3月—2019年5月北京怀柔医院收治的病毒性脑炎患儿82例，随机分成对照组（41例）和治疗组（41例）。对照组静脉滴注注射用阿昔洛韦，每次10 mg/kg，1次/8 h，每次滴注时间＞1 h。治疗组在对照组基础上给予安宫牛黄丸，1～3岁者，0.75 g/次；4～6岁者，1.5 g/次；7～12岁者，3 g/次；1次/d，每次将安宫牛黄丸加入15 mL生理盐水中制成匀浆液，口服或鼻饲。两组患儿均连续治疗14 d。观察两组患者临床疗效，同时比较治疗前后两组患者主要症状和体征改善时间，外周血白细胞计数（WBC）、中性粒细胞百分率（NEUT%）值及脑脊液WBC值和脑电图异常率，脑脊液肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）、金属基质蛋白酶-9（MMP-9）和神经元特异性烯醇化酶（NSE）水平。结果 治疗后，对照组临床有效率为80.49%，显著低于治疗组的95.12%，两组比较差异具有统计学意义（P<0.05）。治疗后，治疗组主要症状、体征的改善时间比对照组显著缩短（P<0.05）。治疗后，两组患儿外周血WBC、NEUT%值及脑脊液WBC值和脑电图异常率均显著降低（P<0.05），且治疗组以上常规理化指标明显低于对照组（P<0.05）。治疗后，两组患儿脑脊液中TNF-α、IL-6、MMP-9、NSE浓度均显著降低（P<0.05），且治疗组比对照组降低更明显（P<0.05）。结论 安宫牛黄丸联合阿昔洛韦治疗儿童病毒性脑炎的整体疗效显著，能迅速缓解患儿发热、抽搐等症状及体征，减少脑部异常放电，抑制脑组织炎症反应，减轻脑损伤。

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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