累及神经系统的手足口病70例

Seventy Cases of Hand-Foot-and-Mouth Disease with Neurological Involvement

目的探讨重症手足口病(HFMD)的临床特点和实验室检查指标,分析神经系统早期病变的特征及危重型病例的危险因素,以利于疾病早期诊断和治疗,降低病死率。方法对本院重症监护室2010年3月-2011年6月收治的70例重症HFMD患儿的临床资料进行回顾性分析,根据临床特征将70例患儿分为重型组和危重型组,比较2组神经系统、呼吸和循环系统的表现及实验室检查的差异。Logistic回归分析进展为危重型HFMD的危险因素。结果 70例重症HFMD患儿中,男43例,女27例;<3岁55例(78.6%);重型组41例(58.6%),危重型组29例(41.4%)。高热(≥39℃)38例(54.3%),典型皮疹50例(71.4%)。神经系统主要表现:精神差59例(84.3%),惊跳51例(72.9%),意识障碍38例(54.3%),肢体震颤31例(44.3%),呕吐24例(34.3%),膝反射异常41例(58.6%);呼吸和循环系统表现:呼吸浅快11例(15.7%),呼吸节律不规则15例(21.4%),肺水肿18例(25.7%),心率增快28例(40.0%),血压升高14例(20%),出汗8例(11.4%),毛细血管充盈时间(CRT)>5 s 11例(15.7%);血白细胞>12×109L-138例(54.3%),血糖>6 mmol.L-139例(55.7%)。危重型组在肢体无力、意识障碍、抽搐、膝反射减弱/消失、肌张力降低、呼吸浅快、呼吸节律不规则、心率增快、血压升高、出汗、CRT>5 s、高血糖、不典型皮疹的发生率方面明显高于重型组,差异均有统计学意义(Pa<0.05)。多因素Logistic回归分析发现,意识障碍、呼吸节律不规则、心率增快、高血糖、不典型皮疹是进展为危重型HFMD的危险因素。结论精神差、惊跳、意识障碍、肢体震颤、呕吐、膝反射异常是神经系统早期病变的表现;意识障碍、呼吸不规则、心率增快、高血糖、不典型皮疹是进展为危重型HFMD的危险因素。

Objective To detect the early symptoms and signs of neurological complications and the risk factors associated with critical illness through evaluating the clinical manifestations and laboratory data of severe hand- foot- and- mouth disease （HFMD）in children, and thus provide information for early diagnosis and treatment to reduce its mortality. Methods The clinical data of 70 cases of severe HFMD ad- mitted to Intensive Care Unit of Shenzhen Children＇s Hospital from Mar. 2010 to Jul. 2011 were retrospectively analyzed. According to the clinical manifestations,70 cases were divided into severe group and critical group. The variables including the clinical manifestations of ner- vous, respiratory and circulatory systems, and the laboratory data were compared between the 2 groups. The risk factors for critical illness were analyzed by logistic regression. Results Seventy cases of HFMD were analyzed including 43 male and 27 female ,55 cases were younger than 3 years old（78.6% ） ,41 cases in the severe group（58.6% ） and 29 cases in the critical group（41.4% ） ,38 cases with high fever（54.3% ）, 50 cases with typical rash（71.4% ）. The main neurological features including fatigue（59 cases,84.3% ） ,irritation （51 cases,72.9% ） ,con- sciousness disorders（38 cases,54.3% ） ,limb tremor（31 cases,44.3% ） ,vomiting（24 cases,34.3% ） and knee jerk abnomality（4l cases, 58.6% ）. The clinical manifestations of respiratory and circulatory systems including tachypnea （ 11 cases, 15.7% ）, respiratory rhythm abnor- mality（ 15 cases ,21.4% ）, pulmonary edema（ 18 cases ,25.7% ） ,tachycardia（ 28 cases ,40.0% ）, hypertension（ 14 cases ,20% ）, sweating（ 8 cases, 11.4% ）and capillary refill time （CRT） more than 5 seconds （ 11 cases, 15.7% ）. Laboratory data showed that 38 cases （54.3 % ）with a peripheral blood WBC count more than 12 × 10^9 L^-1, and 39 cases （55.7%）with blood glucose level more than 6 mmol ~ L-1. Between the critical group and the severe group, there were significant differences in limb weakness, consciousness disorders, convulsion, knee jerk de- crease/disappear, hypomyotonia, taehypnea, respiratory rhythm abnormality, tachycardia, hypertension, sweating, CRT more than 5 seconds, hyperglycemia and the atypical rash（ Pa 〈 0. 05 ）. Consciousness disorders ,respiratory rhythm abnormality ,tachycardia, hyperglycemia and the atypical rash were risk factors for the critical cases of HFMD by multivariate logistic regression. Conclusions The early symptoms and signs of neurological complications caused by HFMD are fatigue, irritation, consciousness disorders,limb tremor, vomiting and knee jerk abnomality. The risk factors for critical cases of HFMD are consciousness disorders,respiratory rhythm abnormality,tachycardia, hyperglycemia and the a- typical rash.