昆明地区150例手足口病临床分析

Kunming area in 150 cases of hand-foot-mouth disease clinical analysis

目的探讨笔者所在医院收治的手足口病的临床表现、诊断及治疗措施,从而探讨昆明地区手足口病的发病情况,为手足口病的防治提供理论依据。方法对笔者所在医院接诊的住院治疗病例临床资料进行回顾性分析。结果手足口病多发生于4岁以下儿童,占86.7%(130/150),大多数病例临床表现轻,预后良好。近1/3病例并存下呼吸道感染,近1/5病例存在呕吐。实验室检查近1/3白细胞总数升高,少数心肌酶谱异常,极少数血糖升高。病原学检查CoxA16核酸阳性占33.3%,EV71核酸阳性占11.3%,CoxA16及EV71核酸均阴性占44.7%。重症病例均并发了中枢神经系统损害,其中包括,病毒性脑炎4例,神经原性肺水肿2例,共占4.0%(6/150)。结论 2010年昆明地区手足口病流行的主要病原体可能为CoxA16,其次为EV71。手足口病是一种多发生于学龄前儿童的传染病,可发生多脏器功能损害的全身性疾病,既有隐性感染,也有显性感染,既有轻型感染,也有重型感染病例。应提高重症病例早期临床征象的识别能力,并积极治疗以降低手足口病的病死率。重症病例治疗成功的关键是早期识别危重病例,及时辅助呼吸,同时降低颅内压,大剂量糖皮质激素及免疫球蛋白的应用,防止神经源性肺水肿的发生。

Objective To explore hand-foot-and-mouth disease clinical manifestation,diagnosis and treatment measures,and explores kunming area of hand-foot-and-mouth disease incidence,for hand-foot-and-mouth disease prevention provide theory basis.Methods In our accepts hospitalizations cases clinical data were retrospectively analysed.Results Hand-foot-and-mouth disease happens at 4,children under the age of 86.7%（130/150）,most cases clinical manifestations of light,the prognosis is good.Nearly 1/3 cases coexist lrti,nearly 1 in 5 cases exist vomiting.Laboratory tests nearly 1/3 leukocytes total increases,the minority myocardial enzyme glucose abnormalities,a few.Etiology check CoxA16 nucleic acid positive 35%,but EV71 nucleic acid positive occupy 12%,CoxA16 and EV71 nucleic acid were all negative 47%.In severe cases concurrent the CNS,including,viral encephalitis 4 cases,neurons sex pulmonary edema in 2 cases,which together account for over 4 per cent（6/150）.Conclusion The 2010 Kunming area HFMD popular main pathogen is likely to CoxA16,followed by EV71.Hand-foot-and-mouth disease is a happens at preschool children infectious diseases,can happen much viscera function impairment of systemic disease,both recessive infection,also have an apparent infection,both light infection,also have heavy infections.In severe cases should improve the early clinical manifestations of recognizing ability,and active therapy to reduce hand-foot-and-mouth disease mortality.In severe cases is the key to successful treatment of the early recognition of serious disease,timely help to breathe,at the same time,reduce intracranial pressure,high-dose glucocorticoids and immunoglobulin application,prevent the occurrence of neurogenic pulmonary edema.