危重手足口病并发脑干脑炎68例临床分析

Severe hand foot and mouth disease in 68 children with brainstem encephalitis

目的探讨儿童危重症手足口病（hand foot and mouth disease, HFMD）的临床特点及危险因素。方法回顾性分析2010年4月至9月收治的68例确诊并发脑干脑炎的危重症HFMD患儿的临床资料。结果68例患儿中，年龄〈3岁63例（92．6％），均出现皮疹、发热（100％），精神差68例（100％），易惊65例（95．6％），嗜睡42例（61．8％），呕吐28例（41．2％），肢体震颤23例（33．8％），腱反射活跃60例（88．2％），呼吸浅促或呼吸节律不整63例（92．6％），心率增快65例（95．6％），血压升高54例（79．4％）。WBC〉12×10^9／L25例（36．8％，25／68），血糖升高19例（27．9％，19／68）。x线胸片示单、双侧肺野点片状或片絮状阴影46例（67．6％，46／68）。48例患儿行头颅MⅪ检查，其中8例可见缺血性病灶或脱髓鞘改变；3例弛缓性瘫痪患儿行脊髓MRI检查均示脱髓鞘改变。肛拭子病原学检查示肠道病毒71型阳性38例（55．9％，38／68），其他肠道病毒阳性25例（36．8％，25／68），阴性5例（7．3％，5／68）。68例患儿均行气管插管机械通气治疗，63例治愈，4例好转出院，1例放弃治疗死亡。结论年龄〈3岁、肠道病毒71型感染、持续发热、精神差、嗜睡、易惊、呕吐、肢体震颤、腱反射活跃、呼吸浅促或呼吸节律不整、心率增快、血压升高是本组HFMD患儿进展为危重症的危险因素。及早识别危重症HFMD患儿的危险因素，早期干预治疗、机械通气是降低本病病死率的关键。

Objective To explore the clinical features and risk factors of children with severe hand foot and mouth disease （HFMD）. Methods The clinical data of 68 children with HFMD associated with brainstem encephalitis were analysed retrospectively from Apr to Sep 2010. Results Among the 68 cases,63 cases （92. 6% ） were younger than 3 years. The major symptoms and physical signs of 68 cases included rash （68 cases,100% ） ,fever （68 cases,100% ） ,fatigue （68 cases,100% ） ,irritability （65 cases,95.6% ） ,som- nolence （42 cases,61.8% ） ,vomiting （28 cases,41.2% ） ,limb tremor （23 cases,33.8% ） ,tendon reflexe hyperactivity （60 cases, 88. 2 % ）, tachypnea or respiratory rhythm abnormality .（63 cases,92. 6% ）, tachycardin （65 cases,95.6 % ）, and hypertension （54 cases,79.4 % ）. Twenty-five cases （36. 8 % ,25/68 ） had leucocytosis （ 12×10^9/L）, and 19 cases （ 27.9%, 19/68 ） had hyperglycaemia. X-ray appearances： patchy and pathy shadows in single or bilateral pulmonary were seen in 46 cases （67. 6% ,46/68）. Forty-eight cases were examined by MRI, eight cases displayed ischemic lesions or demyelination. Spinal cord MRI was performed in 3 cases with flaccid paralysis, which showed demyelination. The etiology indicated that 38 cases（55.9%, 38/68 ） were infected by enterovirus 71,25 cases （36. 8 %, 25/68） were infected by other enterovirus,5 cases （7.3 %, 5/68 ） were negative. All the cases were treated by mechanical ventilation with tracheal intubation,in whom 63 cases recovered well,4 cases improved,and 1 case gave up to die. Conclusion Ages 〈3 years,en- terovirus 71 infection, continual fever, fatigue, somnolence, irritability, vomiting, limb tremor, tendon reflexes hyperactivity, tachypnea or respiratory rhythm abnormality,tachycardia and hypertension are the high risks of critically ill children associated with severe HFMD. To reduce the fatality rate of HFMD, it is crucial to early judge the high risk factors, and take mechanical ventilations earlier.