重症监测治疗技术对重症手足口病患儿病情及预后的影响

Effect of the Intensive Care Technical on the Pathogenetic Condition and Prognosis of Severe Hand, Foot and Mouth Disease

目的：将重症监测治疗技术应用于重症手足口病患儿的救治，以探讨对病情及预后的影响。方法：选择自2009年1月1日-2009年9月6日24时入住我院手足口病重症病房的重症手足口病患儿492例．分析：①发病年龄．性别。（2）最高体温、皮疹、严重表现及并发症等。（3）机械通气患儿的带机时间。机械通气并发症。（4）WBC、血糖、血乳酸、心肌酶、肝功酶．胸片及病原学检查等辅助检查结果。应用重症监测治疗技术及脏器功能支持等。结果：83．7％患儿年龄在3岁以下：100％患儿发热；100％患儿口腔或手、足、臀部有皮疹。神经系统并发症表现为精神差．易惊、肢体抖动，嗜睡；呼吸系统表现为呼吸急促、浅慢，节律不规则；循环系统表现为心率增快、减慢．血压增高或降低、皮肤花斑、四肢皮温低；辅助检查：部分病例出现血WBC、AST．ALT、CK-MB和血糖、血乳酸升高，咽拭子EV71-PCR阳性率36．6％．肛拭EV71-PCR阳性率41．9％。胸片表现为肺纹理增粗。渗出或无明显异常。机械通气患儿147例。492例患儿治愈489例．死亡3例，死亡率0．61％。无1例患儿有机械通气并发症及神经系统后遗症。结论：在本次手足口病救治中。应用重症监测治疗技术对重症患儿各个脏器系统进行监测治疗，可降低死亡率．减少并发症，避免神经系统并发症。

Objective： To explore the impact of intensive monitoring and treatment technology on the pathogenetic condition and prognosis of severe hand-foot- mouth disease（HFMD） cases. Methods： Select from Intensive care unit in Liaocheng peoples＇hospital from January 1to September 6 in 2009 and analyze ：1. Age at onset, sex .2 The maximum body temperature, erythra, severe manifestations and complications.3.the time and complications mechanical ventilation.4, auxiliary examination referred to white blood cell, blood glucose, blood lactic acid, cardiac enzymes, liver enzymes, chest X-ray and etiological examination.Use intensive monitoring and treatment technology on the children. Results： 83.7% of children were under 3 years. All children had fever and exanthem in mouth, hand, foot, or haunch. Neurological complications were worse for mental performance, hyperarousal and limb shaking, lethargy. Respiratory complications showed shortness of breath, shallow slow, irregular rhythm; circulatory system complications manifested as increased heart rate, decreased heart rate, hyperpiesia, hypopiesia , piebald skin, low limb skin temperature. Auxiliary examination： WBC, AST, ALl＇, CK-MB and blood glucose, blood lactic acid increased in some cases, throat swab EV71-PCR positive rate was 36.6%, rectal swab EV71-PCR positive rate was 41.9%.Chest X-ray showed lung markings thickening, effusion, or no obvious abnormality. In 492 critical illness cases, 147 cases was mechanical ventilational, 489 cases was cured, and 3 died. The mortality rate 0.61%. No one had mechanical ventilation complications and neurological sequelae. Conclusion： The critical hand-foot-mouth disease was severe, changed quickly. When complicating neurogenic pulmonary edema it was difficult to treat and was in a high fatality rate. Identificating critical illness children early and utilizing intensive monitoring and treatment technologies timely could reduce mortality and complications as well as avoid the complications of the nervous system.