小儿重型手足口病312例临床分析

Clinical analysis of 312 children of severe hand-foot-mouth diseasey

目的探讨重型手足口病患儿的临床特点,特别是神经系统的早期表现,以提高早期诊断率。方法回顾性分析2011年1～12月收治的312例重型手足口病患儿的临床表现、检查结果及诊断情况。结果 67.6%的患儿为1～3岁。97.1%的患儿在病程1～5天发展成重症,尤以病程2～4天(77.2%)更明显。绝大部分患儿出现精神差(99.0%)、惊跳(95.8%)、激惹(94.9%)、呕吐(38.5%)、肢体抖动(30.1%)、嗜睡(10.6%)、头痛(8.3%)、惊厥(2.2%)、颈阻阳性(16.0%),巴氏征阳性(11.9%)、膝反射活跃或亢进或减弱(16.6%)、心率增快(83.3%)、血压增高(42.3%);61.2%的患儿外周血白细胞计数增高,34%的患儿血糖增高,34.6%的患儿血乳酸增高;脑脊液检查(34/40例)阳性率高,为病毒性脑炎改变;脑CT(0/21例)、脑MRI(0/11例)检查阳性率低。312例均临床治愈,无1例发展为危重型及死亡。结论重型手足口病早期临床表现较隐匿,精神差、惊跳、激惹为神经系统最主要表现,呕吐、肢体抖动提示病情较重,头痛不是神经系统主要表现,较少出现惊厥、昏迷。持续发热、心率增快、血压增高、外周血白细胞计数增高、血糖增高、血乳酸增高为诊断重型手足口病的重要依据,神经系统体征、脑CT、脑MRI检查不能作为诊断依据。早期诊断,及时治疗,则预后良好。

Objective To analyze the clinical feature and test result of severe care children with hand-foot-mouth disease（HFMD）,especially the early performance of the nervous system for timely diagnosis.Methods 312 severe care children with HFMD in our department from Jan 2011 to December 2011 were analyzed.Results 67.6 percent of these children with HFMD were around 1-3 year old,only very small numbers of children were more than 5 years old.97.1% of these children became critical patients in the course of the first five days,especially in the course of 2 to 4 days（77.2%）.The majority of cases show fatigue（99.0%）,irritation（95.8%）,restlessness（94.9%）,38.5% of them were with vomiting,30.1% of them present limb tremor,and 10.6% of them were with somnolence.The neurological features include headache（8.3%）,convulsions（2.2%）,stiff neck（16.0%）,Babinski positive（11.9%）,double knee reflex hyperactivity（16.6%）.No cases were with convulsions.83.3% cases were with tachycardia,42.3% were with hypertension.61.2% of them persent peripheral white blood cell count increased,34% of them were with hyperglycemia,and 34.6% of them were blood lactate increased.Cerebrospinal fluid examination（34/40） positive rate of change of viral encephalitis,brain CT scan（0/21） and brain MRI scan（0/11） positive rate is low.312 cases were cured without progression and death.Conclusion The early clinical features of severe care cases with HFMD is hard to detect.The typical neurological features include fatigue,irritation,and restlessness.Vomiting and limb tremor are the hint of severe condition,Headache is not the main sign of neurological complications,rarely shows convulsions and coma.Persistent fever,tachycardia,hypertension,peripheral blood leukocyte count increased,blood glucose increased,blood lactate increased are the important signs for the diagnosis of severe HFMD disease.Whereas neurological signs,brain CT scan and brain MRI scan can not be used as a diagnostic basis.The prognosis of HFMD will be ideal with proper treatment,early diagnose and prompt adjustment of therapy according to vital sign.