重症手足口病分组监护治疗80例分析

Critical care and therapy based different illness state of 80 patients with severe hand-foot-and- mouth disease seen in Shenzhen

目的探讨阻止重症手足口病向危重症进展以及提高危重症抢救成功率的救治方案。方法根据有无神经系统和其他并发症及其程度，将80例重症手足口病患儿分为A、B、C、D3组。各组分别给予不同强度监护治疗方案，分析总结各组疗效及预后。统计学处理使用SPSS13．0软件，统计学方法采用方差分析或卡方检验。结果重症手足口病累及神经系统受累时，最多出现的症状是持续发热（69／70）和四肢抖动（67／70），病情重者皮疹相对少。脑干病变伴肺水肿者常出现心动过速〉200次／min、血压升高、外周血白细胞增高、血糖增高。脑脊液细胞数、CRP与病情轻重无关。神经系统受累与EV71感染高度相关。A、B、C3组共69例，全部治愈。D组11例，其中6例并发神经源性肺水肿和循环衰竭，死亡2例，9例抢救成功，其中8例痊愈，1例遗留智障及运动障碍。结论神经系统受累的手足口病重症病例，及时合理使用甘露醇、甲基泼尼松龙、丙种球蛋白以及其他对症支持措施，可能对阻止重症病例向危重状态发展和降低危重症病死率有益。

Objective To discuss the treatment strategy of severe hand-foot-and-mouth disease （HFMD） cases, prevent the severe cases from progressing to fatal condition and enhance the survival rate of critically ill patients. Methods Eighty HFMD cases were divided into four groups, A, B, C and D, according to the severity of patients＇ nervous system manifestation and other system involved. Different intensive care and treatments were used and the effect and outcome were analyzed for each group. All statistical analyses were performed by using SPSS software 13.0. One-way ANOVA and Chi-square test were used for data analysis. Results The most common symptoms were continuous fever （69/70） and myoclonic jerk （67/70）. The fewer the rashes were, the more severe the patient＇s condition was, heart rate 〉 200/ min, hypertension, increase of white blood cells in peripheral blood and hyperglycemia were common in patients with lesions in brain stem and pulmonary edema. There were no relations between patient＇s conditions and CSF white blood cells and CRP. CNS involvement was highly associated with EF71 infection. There were 69 cases in group A, B and C in total and all recovered. Of 11 patients in group D, 6 got complicated neurogenic pulmonary edema and circulatory failure, 2 cases died and 9 cases survived, 8 cases recovered without sequelae while one case had sequelae of mental retardation and dyscinesia. Conclusion Administration of mannitol, methylprednisolone, IVIG and other supportive treatments in time and reasonably might have advantages in avoiding aggravation of the condition and enhancing the rate of successful rescue in patients with nervous system involvement.