重症手足口病并脑炎在呼吸机高级生命支持中3%氯化钠治疗价值的临床研究

Investigation on 3% Sodium Chloride in the Adjuvant Therapy of Severe Hand Foot and Mouth Disease with Encephalitis

目的:评价3%氯化钠在重症手足口病并脑炎辅助治疗的疗效与安全性。方法:将85例重症手足口病并脑炎患儿,随机分为治疗组45例与对照组40例,均给予呼吸机辅助通气,静注丙种球蛋白、甲泼尼龙、20%甘露醇、速尿及降温、镇静、止惊等综合治疗。治疗组在此基础上早期加用3%氯化钠辅助治疗,观察两组患儿精神状态恢复、肢体震颤缓解、外周循环改善的时间及呼吸机使用时间、住院时间、电解质紊乱、神经系统后遗症情况。结果:治疗组在呼吸机使用时间、精神状态恢复、肢体震颤缓解、外周循环改善方面优于对照组。与对照组相比,治疗组的住院时间缩短、低钠血症和神经系统后遗症的发生率均下降,差异均有统计学意义(P<0.05)。结论:3%氯化钠在辅助治疗重症手足口病并脑炎中疗效显著,不良反应少,安全可靠,适合基层医院推广应用。

Objective： To investigate the efficacy and safety of 3% sodium chloride as adjuvant therapy of severe hand foot and mouth disease with encephalitis.Method： 85 cases of severe hand foot and mouth disease with encephalitis were randomly divided into two groups,the control group containing 40 cases and the treatment group containing 45 cases.Both of the groups received comprehensive treatment,including assisted mechanical ventilation,intravenous gamma globulin,methyl-prednisolone,20% mannitol,furosemide,cooling,sedation,anticonvulsion and so on.Beside the treatments,the treatment group also received adjuvant therapy of 3% sodium chloride at the early time.The recovery of the mental state,relief of limb tremor,the time of improved peripheral circulation,the time of mechanical ventilation,the duraion of hospital stay,electrolyte imbalance and neurological sequelae were compared between the two groups.Result： The treatment group displayed better time of mechanical ventilation,recovery of mental state,relief of limb tremor and improved peripheral circulation than the control group.Moreover,the treatment group also showed shorter duration of hospital stay,lower incidence of hyponatremia and neurological sequelae.The difference between the two groups was statistically significant,P0.05.Conclusion： 3% sodium chloride as adjuvant therapy of severe hand foot and mouth disease with encephalitis has obvious curative effect with safety and fewer adverse reactions.It is suitable for primary hospitals popularization and application.