儿童危重症手足口病诊治分析

Clinical Diagnosis and Treatment of Severe Hand-foot-mouth Disease in Children

目的：探讨危重症手足口病的早期临床表现、高危因素及治疗方法。方法对59例患儿的临床表现及治疗方法进行回顾性分析。结果危重症手足口病的临床特征：年龄多在3岁以下；病原以EV71为主；最常出现的神经系统表现有精神差、呕吐、惊跳、肢体震颤，其他严重表现有心率增快、血压升高、末梢循环不良、呼吸增快及节律异常，外周血WBC增高，血糖明显升高。其中，EV71感染在3岁以内发病率更高，但其感染患儿的性别、发病季节和非EV71感染的手足口病患儿差异并无统计学意义。另外，EV71感染虽危重症发病率高，但其危重症临床表现与其他危重症患儿差异并无统计学意义。除常规治疗外，49例患儿使用呼吸机辅助通气，1例死亡，4例自动出院放弃治疗，余均好转出院。随访1年，未发现肢体瘫痪、继发性癫痫及明显的智力落后。结论及早识别危重症手足口病患儿的高危因素、及早进行干预治疗是降低病死率、改善患儿预后的关键。

Objective To investigate the early clinical manifestations, risk factors and treatment of severe hand, foot and mouth disease (HFMD). Methods The clinical features, laboratory examinations, treatment and outcomes of 59 severe HFMD admitted from May 2009 to October 2013 were analyzed. Results The main clinical features of severe HFMD include:younger than 3 years old;most of them can detect EV71;listlessness, vomiting, startle, limb tremor were the most common features of nervous system;tachycardia, high blood pressure, poor peripheral circulation, tachypnea and abnormal rhythms, increased peripheral WBC, hyperglycemia were the other serious manifestations. The EV71 infection higher incidence in less than 3 years old, but the sex and the onset of the season had no difference than other pathogens. EV71 infection results in multiplication of the severe HFMD but have no difference about the clinical manifestations of others. In addition to the conventional therapy, mechanical ventilation were used for 49 cases, 1 died, 4 cases were discharged abandon treatment, others were back to health. We found no paralysis of limbs, obvious secondary epilepsy and mental retardation of them with 1 year follow up. Conclusion The key to reduce mortality and improve the prognosis of severe HFMD is early to identify the severe HFMD risk factors and early intervention.