2011年南京地区120例手足口病的临床特点及治疗体会

Clinical characteristics and treatment experience of 120 cases of hand,foot and mouth disease in Nanjing,2011

目的回顾性分析120例手足口病病例的早期临床特征,普通病例与重症型病例进行比较。方法用回顾性调查分析法,对所收集的临床资料进行归纳总结、统计分析。结果手足口病的发病年龄主要集中在1～4岁,普通型主要表现为中等程度发热,皮疹;重症型病例入院后仍有持续高热3～5 d(70%),热峰多在39.0°C以上、皮疹稀少(63.3%)、精神萎靡及嗜睡或哭闹(75%)、肢体抖动或肌阵挛(86.6%)、呕吐(58.3%)、反复抽搐(5%)、神经系统阳性体征(25%)、血白细胞升高(66.2%)和血糖升高(58.3%),以上所述是早期诊断手足口病重症型病例的重要临床表现及检测指标。对以上特征进行比较,普通型与重症型差别有统计学意义(P<0.05)。通过抗病毒、甘露醇和甘油果糖、静脉丙种球蛋白、糖皮质激素为主的早期治疗,仅1例进展为危重型,患儿无一例死亡,未见不良反应。结论加强对小儿手足口病的临床观察,及时发现重症倾向,早期诊断,积极治疗,能有效阻止病情进展。

Objective To analyze the early clinical features of 120 severe cases with handfootmouth disease （HFMD） and to compare regular eases with those of the severe cases. Methods Retrospective analysis was used. The clinical data were summarized and ana lyzed. Results Clinical data showed that the age of most cases was from 1～4 yearold. The clinical manifestations of the regular cases were moderate fever and rash. The clinieal manifestations of the severe cases included sustained high fever （70.,.%） for 3 5 days, fewer rash （63.3%）, lethargy, somnolence or restlessness （75%）, body trembling or muscle spasm （86.6%）, vomiting （58.3%）, repeat ed spasm （5%）, positive neurotic features（25% ）, high white cell count （66.2%） and high blood glucose level （58.3%）. There were significant differences in presentation of the above features between severe cases and regular cases of HFMD （ P 〈 0.05 ）. Early treatment with antivirus, mannitol and glycerol fructose, mannitol, ganma globulin and glucocorticoids were effective. No death was re ported and no side effects were found. Conclusion Enhaeement of clinical observation,intime discovery of severe cases, early diagnosis and treatment can effectively prevent the deterioration of disease.