血管活性药物的及早干预对重型及危重型手足口病预后的影响

Prognostic influences of early intervention to serious and dangerous type of hand-foot-mouth disease by vaso-active pharmaceuticals

目的分析研究重型及危重型手足口病多脏器损害的发生机制,总结及探讨抢救经验。方法所有重型及危重型患者入院后在应用基础药物的同时马上启用多巴胺2～5μg/(kg.min)、酚妥拉明2～5μg/(kg.min),持续24 h血管内泵入连续数天;凡有:①体温>38℃;②惊跳;③震颤;④抽搐一项者加用氯丙嗪、异丙嗪各1 mg/kg每次,每4～6小时1次血管注入连续数天至上述症状消失;四肢冰冷、精神萎靡、休克者于1 h内注入盐水15～20 ml/kg,必要时重复1次,持续应用多巴胺6μg/(kg.min),不用酚妥拉明与氯丙嗪、异丙嗪;肺部广泛湿啰音者调整酚妥拉明与多巴胺比例。结果 187例重型及28例危重型患者中的24例疾病进展迅速得到中止及逆转。治疗结果全部治愈。无一例需插管上呼吸机,无一例死亡,抢救效果满意。4例送达时已是危重型终末期患儿,尽管立即应用呼吸机仍无法存活。结论增加血管活性药物能有效中止与逆转所有重型患者及危重型早中期患者的病情进展,但对终末期危重型患者无效。

Objective To analyze and research the occurrence principle of multi-viscera damage of serious and dangerous hand-foot-mouth disease.To draw a conclusion and discuss the rescue experience.Methods After all of the serious and dangerous patients were hospitalized,while using the basal pharmaceuticals,we should also start to use dopamine by 2-5 μg/（kg·min） and phentolamine by 2-5 μg/（kg·min） with 24 hours＇ continuous pumping inlet blood vessel for several days.If any one of following items appears,please add chlorpromazine and promethazine by 1 mg/kg,q 4-6 h respectively by intravascular injection for several days continuously till the following symptoms disappear： ①Body Temperature38 ℃;②Jumping;③Fremitus;④Hyperspasmia.If hands and feet were cold,phychosis was dispirited or shock,please inject saline 15-20 ml/kg within one hour,repeat it if necessary.Use dopamine by 6 μg/（kg·min） continuously.Don＇t use phentolamine,chlorpromazine and promethazine.If lungs with moist rales were widely,please adjust the ratio of phentolamine and dopamine.Results Among 187 cases of serious type and 28 cases of dangerous type of patients,there were 24 cases of patients＇ disease development being interrupted and improved.Finally,they were all cured.There was no one needing to intubate up breathing machine.No one dead.The rescue result was satisfactory.Though 4 cases of dangerous and serious terminal baby patients have been set the up breathing machine at once,they still cannot survive.Conclusion Adding vaso-active pharmaceuticals can effectively interrupt and improve the development of all serious and dangerous early and intermediate patients＇ illness,but it is useless to those who are terminal dangerous and serious patients.