危重症手足口病30例诊治体会

Clinical analysis of 30 children with severe hand,foot and mouth disease

目的:探讨危重症手足口病(HFMD)的早期临床表现、诊断、高危因素及治疗方法。方法:对30例危重症手足口病患儿的临床表现及治疗方法进行回顾性分析。结果:本组30例中,3岁以内占96.7%,持续发热,精神差、呕吐、肢体肌阵挛、呼吸、心率增快各占100%;白细胞增高(WBC≥10×109)、胸部X线片示肺水肿也占100%;肢体无力、血压升高、T淋巴细胞转化率<60%、心肌酶异常、EV71-RNA(+)也达到50%以上。给予抗病毒、退热、大剂量免疫球蛋白(IVIG)、甲基强的松龙等治疗后,临床治愈率可达56%以上。结论:重症手足口病多见于3岁以内患儿,临床以持续发热,精神差、呕吐、肢体肌阵挛、呼吸、心率加快、肢体无力、血压升高、白细胞增高、T淋巴细胞转化率<60%、心肌酶异常、EV71-RNA(+)及胸部X线片示肺水肿为其特点。临床医生应高度重视高危因素,密切观察病情,及早干预治疗,是提高抢救成功率,降低病死率的关键。

Objective：To analyse the clinical manifestations of severe hand,foot and mouth disease,summarize the diagnostic basis,and explore the efficient methods of earlier detection,positive intervention and blocking the development of the disease on high risk factor.Methods： The clinical data of 30 child patients with HFMD in our hospital from April 2008 to July 2010 were analyzed retrospectively.Results： Except the skin rash on hand,foot and mouth,the mainly manifestations were：patients under 3 year-old,constant fever,short of vigor,vomiting,limb myoclonus,weakness of limbs,convulsion,respiration and tachycardia augmented,cold sweat,poor peripheral circulation,obvious increase of hypertension or hypotension peripheral leukocyte count,blood glucose elevation,phlegm sound in throat,failed to speak,cohesive eye,？uvula skew,Shoaling nasolabial fold,deflected mouth,quick abnormal chest dynamic change;All of the 30 children had the symptom of pulmonary edema,17 had evehigh risk factors wich was found in time and cured after taking effective treatments,7 died,6 given up treatment,and the given-up cases all died after then.Conclusion： Clinical doctors must pay serious attention to high risk factors and select the patients with high risk factors,carry out the intervention therapy,it is the key to increase cure rate,once pulmonary edema appeared,the death rate will be high.