106例重症手足口病的临床特点分析

Analysis of Clinical Features of 106 Cases of Severe Hand, Foot and Mouth Disease

【目的】探讨重症手足口病的临床特点，以期早期识别、及时干预。【方法】将106例肠道病毒EV71阳性的重症手足口病患儿，分为A组（重症组，n=0）、B组（危重症组，n=17）、C组（死亡组，n=19）三组，分析病例的临床特征。【结果】①入院时三组患者的平均体温均在（39±0．68）℃左右；②表现为惊跳、抽搐的神经系统受累早期症状发生率三组间无显著差异（P〉0．05），表现为嗜睡的发生率，危重组及死亡组显著高于重症组（P〈0．05），死亡组意识改变发生率显著高于另外两组（P〈0．01）；呼吸系统症状中，出现呼吸急促、粉红色泡沫痰者危重症组、死亡组显著高于重症组（P〈0．01），且死亡组亦显著高于危重症组（P〈0．01）；循环系统症状中，心率增快者危重症组与死亡组明显高于重症组（P〈0．05），血压变化三组间无显著性差异（P〉0．05）。③危重症组、死亡组白细胞计数、空腹血糖（FPG）显著高于重症组（P〈0．01）；心肌肌酸激酶同工酶（CK—MB）升高者三组之间比较差异无统计学意义（P〉0．05）。【结论】对于出现惊跳、抽搐、神志改变，呼吸急促、咳粉红色泡沫痰、心率增快，白细胞及血糖升高的手足口病患儿需重视病情，及早发现及干预对提高治愈率尤为重要。

[Objective] To explore the clinical features of severe hand, foot and mouth disease（HFMD） so as to iden- tity early and intervene timely. [Methods] Totally 106 cases of severe HFMD patients with positive enterovirus-71 （EV71） were divided into group A（severe group, n =70）, group B （critical illness group, n = 17） and group C（death group, n = 19）. The clinical features were analyzed. [Results]When admission, the average temperature of 3 groups was （39±0.68）℃. Of nervous symptoms, there was no significant difference in the incidence of nervous symptoms such as startle and twitch among 3 groups（ P 〉0.05）, and the incidence of drowsiness in critical illness group and death group was significantly higher than that in severe group（ P 〈0.05）, and the incidence of consciousness change in death group was significantly higher than that in other 2 groups（ P 〈0.01）. Of respiratory symptoms, the incidence of shortness of breath and pink foam phlegm in death group was significantly higher than that in severe group and critical illness group（all P 〈0. 01）. Of circulatory symptoms, the incidence of increased heart rate in critical illness group and death group was significantly higher than in that in severe group（ P 〈0.05）, while there was no significant difference in blood pressure among 3 groups（ P 〉0.05）. White blood cell count and glucose in critical illness group and death group was significantly higher than that in severe group（ P〈0.01）, while there was no significant difference in increased myocardial enzyme among 3 groups（ P〉0. 05）. [Conclusion]When the patients have the symptoms such as startle, seizures, consciousness change, shortness of breath, cough pink foam phlegm, increased heart rate, white blood cell and blood glucose, the illness state should be paid attention. Early detection and intervention is important to improve the curative rate.