重症手足口病87例临床观察

The clinical phenotypes and high risk factors analysis of 87 cases of hand,foot and mouth disease

目的总结小儿重症手足口病(HFMD)临床表现类型,探讨其早期高危因素。方法对87例小儿重症HFMD住院资料作回顾性总结。结果HFMD病重者87例合并神经系统损害者68例,占78.16%,合并神经系统损害为重症病人的主要表现,精神萎靡和肢体抖动、激惹往往是最初表现和最常见表现。合并循环系统损害者4例,占4.60%,合并持续高热15例(17.24%),重症肺炎3例(3.45%),急性肺水肿2例(2.30%),消化道出血4例(4.60%),明显腹胀3例(3.45%)。87例小儿平均月龄(19.43±3.61)个月,<3岁者69例,占79.31%,与对照组(36/103,34.95%)相比,差异有统计学意义(P<0.01);出现高血压者68例(78.16%);临床发现重症病例随机血糖增高,87例重症病儿平均血糖为(8.91±1.03)mmol/L,与对照组(5.12±1.14)mmol/L相比,差异有统计学意义(P<0.01);87例重症患儿平均周围血白细胞计数为(16.65±4.13)×109/L,与对照组(6.96±1.31)×109/L相比,差异有统计学意义(P<0.01);重症病例组共有79例(90.80%)血象升高,其中中性粒细胞比例同步升高者71例,与对照组22例(21.36%)白细胞升高相比差异有统计学意义(P<0.01)。87例小儿中具有典型疱疹者71例(81.61%),87例小儿经治疗后痊愈出院84例(96.55%),自动出院1例,死亡2例。本病的早期高危因素有:年龄、发病时间、发热、血压升高、血糖升高、血象升高等。结论重症HFMD合并神经系统损害较为常见,应高度关注早期高危因素,进行早期干预,提高救治效果。

Objective To summary the clinical phenotypes and early high risk factors of the children＇s heavy hand, foot and mouth disease. Methods The clinical data of 87 cases of the children＇s heavy hand, foot and mouth disease was retrospectively analyzed. Results 68 cases of the HFMD companied with the nervous system damages. The main features of the heavy patient might be companied by the nervous system damages. The complications of the HFMD included the circulatory system damages [4 （4.60%） ], continued high fever [ 15 （ 17.24% ） ], heavy pneumonia [3（3.45% ） ] ,acute pulmonary edema [2（2.30% ） ] ,alimentary canal hemorrhage [4（4. 60% ） ] ,abdominal distension [ 3 （3.45%） ]. The average monthly age of 87 cases was （ 19.43 × 3.61 ） months, 〈 3 years 69 cases （79.31% ） ;there was the difference between HFMD and the contrast group （P 〈 0. 01 ）. The average glycemia of 87 cases was （8.91 × 1.03 ）mmol/L, and there was the difference between HFMD and the contrast group（P 〈0. 01 ）. The average leukocyte count 87 cases was （ 16. 65 ×4. 13） × 109/L,and there was the difference between HFMD and the contrast group （P 〈 0. 01 ）. 79 cases suffered with the hemogram, and there was the difference of the leukocyte amount between HFMD and the contrast group（P 〈0. 01 ）. 71 cases of the tlFMD suffered with the typical herpes. The cure rate of HFMD was 96.55%. The earliest and most expressions included listless,tremble and easy agitation. The early high risk factors of the disease were age, attack period, fever, promotion of blood pressure, glycemia and hemogram. Conclusion The children heavy hand, foot and mouth disease companies with the typical clinical characteristics and nervous system damages are usually evident. The early diagnosis and treatment are very important.