手足口病并发病毒性脑炎患儿65例临床分析

Clinical analysis on 65 cases of hand,foot and mouth disease complicated with viral encephalitis

目的:探讨手足口病(HFMD)合并病毒性脑炎患儿的临床特点、治疗方法及预后。方法:对65例HFMD并发病毒性脑炎患儿的症状与体征、实验室检查、治疗和转归等临床资料进行回顾性分析。结果:患儿临床表现以发热(100.0%)、皮疹(100.0%)、呕吐(100.0%)、精神差(96.9%)、易激惹(80.0%)、肢体抖动(72.3%)为多见;并发神经源性肺水肿和脑干脑炎各1例;病原学检测32例,其中22例阳性为EV71感染8例、CoxA16感染14例。56例痊愈出院,9例出院时有神经系统后遗症,其中除1例失访,1例仍观察外,其余7例随访半年均恢复正常。结论:HFMD合并病毒性脑炎患儿病情进展迅速,早期诊断、及时呼吸支持、积极降颅压、维护循环功能是救治成功的关键。

Objective：To investigate the clinical features,treatment and prognosis of hand,foot and mouth disease（HFMD） in children complicated with viral encephalitis.Methods：The clinical data including symptoms,signs,laboratory tests,treatment and prognosis of 65 cases of HFMD in children complicated with viral encephalitis were retrospectively analyzed.Results：The clinical manifestations of 65 patients were fever（100.0%）,rash（100.0%）,vomiting（100.0%）,mental difference（96.9%）,irritability（80.0%）,and physical jitter（72.3%）;1 case combined with neurogenic pulmonary edema and 1 case combined with brain stem encephalitis.Pathogens were detected in 32 cases,including 8 cases of EV71 infection,CoxA16 infect in 14 cases.Fifty-six cases were cured,9 cases were discharged with neurological sequelae.Among the above 9 cases,1 patient was failed to follow up,1 patient was still under observation,the remaining 7 cases that were followed up for six months turned to normal.Conclusions：HFMD in children complicated with virus encephalitis progressed rapidly,early diagnosis,prompt respiratory support,and actively reducing intracranial pressure,maintaining circulation are the key points for successfully rescue.