手足口病合并中枢神经系统损害54例临床分析

Clinical analysis of 54 cases of hand, foot and mouth disease with central nervous system damage

目的 分析手足口病合并中枢神经系统损害的典型临床表现,探讨危重症病例的早期识别、早期治疗的指征.方法 采用回顾性病例分析方法,对2010-05～2010-09在我院住院治疗的54例合并中枢神经系统损害的手足口病病例进行临床分析.结果 54例患儿平均年龄（2.7±1.1）岁,男：女为2.4∶ 1.均表现为发热、皮疹（占100%）,伴有惊跳44例（81.5%）,四肢抖动31例（57.4%）,呕吐25例（占46.3%）,精神差14例（占25.9%）,烦躁5例（占9.3%）,嗜睡5例（占9.3%）,惊厥4例（7.4%）,四肢弛缓性瘫痪2例（3.7%）.血糖升高25例（占46.3%）,外周血WBC升高26例（占48.1%）.肠道病毒71型（EV71）检测阳性44例（占81.5%）,柯萨奇A16型（CoxA16）检测阳性13例（占24.1%）,二者混合感染3例（占9.3%）.52例临床治愈（占96.3%）,2例死亡（占3.7%）.结论 EV71更易引起中枢神经系统合并症,四肢抖动及惊跳是危重症手足口病合并中枢神经系统损害的早期明显表现,尤其小于3岁儿童,在高热期出现四肢抖动、惊跳,应警惕合并中枢神经系统损害,早期诊断及治疗有助于提高治愈率.

Objective To analyze the typical clinical manifestations of hand, foot and mouth disease with central nervous sysIem damage and to explore the features of earlier identification and earlier treaent of patients with critical illness. Methods 54 cases of hand, foot and mouth disease with nervous system injury were treated from May 2010 to September 2010 in our hospital by using retrospective analysis method. Methods 54 cases of hand, foot and moulh disease with nervous system injury were treated from May 2010 to September 2010 in our hospital by using retrospective analysis method. Results Average age of 54 patients was （2.7 _＋ 1. 1 ） years old, ratio of males to females was 2.4 ： 1. All patients presented fever and rash （100%） accompanied by irritation in 44 cases （81.5%） , limb tremor in 31 cases （57.4%）, vomiting in 25 cases （46.3%）, fatigue in 14 cases （25.9%）, restlessness in 5 cases （9.3%） , hypersomnia in 5 eases （9.3%） , convulsion in 4 cases （7.4%） , flaccid paralysis of limbs in 2 cases （3.7%）, elevation of blood sugar level in 25 cases （46.3%）, peripheral WBC elevation in 26 cases （48. 1%）, enterovirus （EV） 71 virus- positive in 44 eases （81. 5%）, Coxsackie AI6 type （CoxA16） positive in 13 cases （24.1%） , polyintection of EVT1 and CoxA16 in 3 cases （9.3%）. In total, 52 eases were cured （96.3%） while 2 died （3.7%）. Conclusion The central nervous system complications were more likely to be caused by EV71. Limbs tremor and irritation are the obvious manifestations of critical hand, loot and mouth disease patients with eentral nervous system damage at an early stage, especially children under 3 years old. Limbs tremor amt iiTitation during high fever should be alerted to nervous system damage tor earlier diagnosis and treatment and a higher cure rale.