重症手足口病危象的早期识别与管理

Hand-foot-and-mouth disease crises in early identification and management.

【目的】分析重症手足口病的临床特点,研究其能够早期识别的各种临床危险征象,为如何采取强有力的救治管理措施,及时有效控制病情进展提供依据。【方法】对随州市2009年3月—2009年7月367例重症手足口病住院病例的临床资料进行回顾性分析。【结果】重症手足口病早期危象发生的频度依次为:精神差、持续高热、WBC升高、易惊或肢体肌阵挛、心率增快、呼吸增快、末梢循环不良、高血压、高血糖、抽搐、肢体无力、呕吐。在救治管理中,367例使用了大剂量丙种球蛋白和常量甲强龙,245例静脉注射了甘露醇,85例大剂量使用了甲强龙,47例进行了机械通气。热程4～9 d,皮疹持续3～8 d,住院7～19 d,治愈好转366例,死亡1例。【结论】以早期识别手足口病重症病例危象,应加强管理并尽早强化治疗,是提高抢救成功率,降低病死率的关键。

[Objective] To analyze the hand-foot-and.mouth disease clinical features, research the clinical risks of early signs which can identify and discus how to take strong measures to control the progress of the disease effectively and timely. [Method] 367 hand-foot-and＇mouth disease patients in the clinical data were analyzed retrospectively during March to July in 2009. [Results] Severe crisis occurred early hand-foot-and＇mouth disease is as follows： the spirit of poor, high fever, WBC rise, easy to panic or physically myoclonus, heart rate increased quickly, increased breathing fast, bad peripheral circulation, hypertension, high blood sugar, seizures, limb weakness and vomiting. In the treatment of man- agement, using a large dose of gamma globulin and the constant methylprednisolone in all 367 cases, 245 cases of intrave- nous injection of mannitol, 85 patients with large doses of methylprednisolone and 47 patients had mechanical ventilation. Hot-way 4-9 days, skin eruption lasts 3-8 days, in hospital 7-19 days, 366 cases of cured improved and 1 case died. [Conclusions] According to the hand-foot-and-mouth disease with severe clinical features by closely observation laboratory examinations, severe cases can be early identification crisis; The cases that to severe in short time should be strengthen management and treatment as soon as possible, it＇s important to improve the success rate and reduce the mortality of rescue.