儿童手足口病36例临床分析

Analysis of 36 Children with Hand-Foot-Mouth Disease

目的探讨儿童手足口病(HFMD)的病因及治疗方法。方法对36例确诊为HFMD患儿的粪便进行肠道病毒71型(EV71)和柯萨奇病毒A16(CA16)检测,并对患儿临床表现、实验室检查和治疗进行分析。结果1.粪便检测:EV71RNA(+)19例(52.77%),CA16RNA(+)13例(36.11%),2种病毒均阴性4例(11.11%)。2.临床症状:所有病例均有发热和手、足、口腔斑丘疹和(或)疱疹。3.重症病例早期表现:白细胞明显偏高15例(41.67%),高热持续不退和高血压各10例(27.78%),肺炎8例(22.22%),易惊厥4例(11.11%),嗜睡2例(5.56%)。4.辅助检查:CRP升高10例(27.78%)、低血钠8例(22.22%)、高血糖5例(13.89%)、低血糖5例(13.89%)、轻-中度代谢性酸中毒13例(36.11%)、心肌酶升高5例(13.89%)、心电图ST段下移或T波低平9例(25%)。5.平均住院时间(5.00±1.65)d。结论对HFMD患儿宜采取隔离诊疗观察;对重症早期HFMD患儿,早期发现、早期诊断、早期治疗是控制病情进展的关键。

Objective To explore the disease causes and treatments of children with hand-foot-mouth disease（HFMD）.Methods Thirty-six children with HFMD,Enterovirus（EV71） RNA and coxsacie virus A16（CA16） RNA were detected in stool samples of the patients,and the clinical features（including fever,skin eruption and severe symptoms in early stage）,laboratory tests and therapeutic outcomes of these patients were retrospectively analyzed.Results 1.EV71 RNA and CA16 RNA were respectively found in 19 cases（52.77%） and 13 cases（36.11%）,but both EV71 RNA and CA16 RNA were negative in the test of 4 cases（11.11%）.2.All the patients had fever maculopapule and/or herpes on hands,foot and mouth.3.There were significant increase of blood leukocytes in 15 cases（41.67%）,sustainable high fever in 10 cases（27.78%）,hypertension in 10 cases（27.78%）,pneumonia in 8 cases（22.22%）,ease of fright in 4 cases（11.11%）,somnolence in 2 cases（5.56%）.4.Otherwise,there were high C-reactive protein in 10 cases（27.78%）,low serum sodium in 8 cases（22.22%）,hyperglycemia in 5 cases（13.89%）,hypoglycemia in 5 cases（13.89%）,mild to mode-rate metabolic acidosis in cases（36.11%）,high myocardial enzymes in 5 cases（13.89%）,and ST segment depression and/or wave flat in electrocardiogram in 9 cases（25%）.5.The average time of hospitalization of patients was（5.00±1.65）d.Conclusion Patients with HFMD should be diagnosed and treated in isolating room.Stage treatment based on disease severity is effective.The key to control the progression of HFMD is early discovering,diagnosing,and treating patients with severe symptoms in early stage.