手足口病合并急性驰缓性麻痹临床及电生理分析

Clinical and Electrophysiological Analysis of Hand-Foot-Mouth Disease Combined with Acute Flaccid Paralysis

目的:探讨儿童手足口病(HFMD)合并急性驰缓性麻痹(AFP)的临床特点。方法:2009年1月至2012年1月郑州市儿童医院康复中心收治的HFMD合并AFP患儿79例,对其临床表现、影像学、神经电生理、综合康复治疗等资料进行回顾性分析。结果:单侧上肢瘫痪29例,单侧下肢瘫痪26例,单侧肢体瘫痪7例,双下肢瘫痪11例,四肢瘫痪6例。影像学检查结果示病变多位于第2～7颈椎和(或)第12胸椎至第1腰椎。周围神经功能检查结果示上、下肢神经损伤最多。经过综合康复治疗后,瘫痪预后下肢好于上肢,单下肢好于双下肢,四肢瘫痪者预后最差。结论:对于HFMD合并AFP患儿,进行MRI和周围神经功能检测可对其病变程度和范围进行早期预测及评估,以便及时进行早期康复治疗,减少瘫痪的发生,降低致残率。

Objective： To study the clinical characteristics of 79 cases of hand-foot-mouth disease （HFMD） combined with acute flaccid paralysis （AFP） in children. Methods： The retrospective study was done on 79 cases of HFMD combined with acute flaccid paralysis patients in clinical manifestations, imaging features, neural electrophysiological changes and comprehensive rehabilitation treatments who were diagnosed and treated at the Rehabilitation Center of the Children＇ s Hospital of Zhengzhou City from January 2009 to January 2012. Results： Among 79 patients, there were 29 cases with unilateral upper limb paralysis, 26 with single lower limb paralysis, 7 with limb paralysis, 11 with lower limbs paralysis, 6 with quadriplegia. The imaging results showed the lesions were located in the cervical 2 - 7 and/or chest 12 to waist 1. Peripheral nerve function test results showed that upper and lower extremity nerve injury was most common. After comprehensive rehabilitation, the prognosis in the lower limb paralysis was better than that in the upper limb; the prognosis in the single lower limb paralysis was better than that in the lower limb paralysis; the worst prognosis was in the quadriplegic cases. Conclusions： For HFMD merger AFP in children, MRI and peripheral nerve function tests may promptly assess its severity and scope. Early and timely rehabilitation training could reduce the incidence of paralysis and disabilities in children.