肠道病毒71型重症手足口病致神经源性肺水肿的发病机制及治疗进展

Pathogenesis and treatments of neurogenic pulmonary edema caused by enterovirus 71-induced severe hand-foot-mouth disease

重症手足口病是一种由肠道病毒引起的急性传染病，多发生于学龄前期儿童，肠道病毒71型是其主要病原。少数重症手足口病可累及神经系统和呼吸循环系统，引起脑干脑炎、神经源性肺水肿、肺出血、心肌炎等严重并发症。神经源性肺水肿是肠道病毒71型累及中枢神经系统后出现的急性肺水肿，临床上以进行性呼吸困难和持续低氧血症为特点，早期可仅有心率增快、血压升高等非特异性表现，诊断十分困难。当出现明显气促、大量泡沫痰、双肺湿哕音时，病死率极高。尽管重症手足口病的治疗手段不断进步，但神经源性肺水肿的病因及调控网络较复杂，导致临床疗效欠佳。因此，密切观察、早期诊断、合理治疗对改善预后有重要意义。该文就肠道病毒71型重症手足口病致神经源性肺水肿的发病机制及治疗进展进行阐述。

[ Abstraet] Severe hand-foot-mouth disease is a kind of acute infectious disease caused by enterovirus and more common in pre-school children. Enterovirus 71 is the major pathogen. Damages in nervous,respiratory and circulatory system can be found in several severe cases, which include brainstem encephalitis, neurogenic pulmonary edema, pulmonary hemorrhage, myocarditis and other serious complications. Neurogenic pulmonary e- dema belongs to acute pulmonary edema,which is caused by central nervous system disorders with enterovirus 71 infection. The primary clinical manifestation of neurogenic pulmonary edema are progressive dyspnea and persistent hypoxemia. But it is very difficult to diagnose in the early stage only with increased heart rate and blood pressure. And the mortality is very high when tachypnea, foamy sputum, moist rales suddenly appear. Although there are many treatments to cure severe hand-foot-mouth disease, the therapeutic effect is far from optimal, which may be due to the complexity of causes and regulating networks in neurogenic pulmonary edema. There- fore, close observation, early diagnosis, appropriate treatment are extremely important for the improved prognosis. In this paper, we will review the pathogenesis and treatments of neurogenic pulmonary edema caused by enterovirus 71 -induced severe hand-foot-mouth disease. [ Key words] Severe hand-foot-mouth disease;Enterovirus 71 ;Neurogenic pulmonary edema