儿童重型及危重型手足口病临床特征的研究

Clinicial Features of Hand-foot-mouth Disease in Severe Infant Cases

目的:探讨重型及危重型手足口病的临床特征之间的差异。方法:回顾分析134例重型(A组)和87例(B组)危重型手足口病的临床特点、治疗及转归。结果:B组在精神差,心率加快,呕吐,嗜睡,烦躁不安,肢体无力,呼吸急促,颈抵抗,抽搐,巴氏征,呼吸节律改变,四肢发凉,颈强直,瞳孔对光反射消失,腱反射减弱或消失,肢体瘫痪等临床症状和体征方面比A组严重(P<0.05)。在血白细胞、血糖、CK-MB、脑脊液白细胞和脑脊液糖的升高等实验室检查方面两组患儿无统计学差异(P>0.05)。B组患者脑干损伤的比例高于A组,患儿病原学检查显示EV71引发比例高于CA16(P<0.05)。所有手足口病患者均予以激素和免疫球蛋白治疗,配合积极的脱水降颅压,所有患儿均使用呼吸机辅助通气治疗,A组的好转率优于B组(χ2=2.319,P=0.044)。结论:B组在部分临床症状和体征方面比A组要严重,早期识别两组患者临床特征方面的差异,及时干预治疗,可减少危重型手足口病的死亡率。

Objective：To investigate the clinical features of hand-foot-mouth disease（HFMD） in severe infant cases. Methods：A total of 221 patients with severe HFMD were retrospectively analyzed with the clinical manifestations. 134 cases in group A and 87 cases in group B. The clinical characteristics,treatment and outcome of them were analyzed. Results：There were statistically significant difference between the two groups with clinical features included Mental difference, heart rate, vomiting,drowsiness, have the fidgets, limb weakness, tachypnea, stiff neck, hyperspasmia, Babinski sign, change of respiratory rhythm, coolness of extremities, nuchal rigidity, loss of the pupillary light reflex, diminution or loss of tendon reflexes and paralysis of limbs（P〈0.05）. There were no statistically significant difference between the two groups with Laboratory results included：leukocytes, blood sugar, CK-MB, the rising CSF WBC and sugar（P〉0.05）. Brain MRI indicated brainstem injury were general in group B and cases caused by EV71 were far more than CA16.High-dose hormone and immunoglobulin shock treatment were used accompanied with reducing cranial pressure through dehydration treatment;all of the cases used breathing machines. It was higher in group A than group B with improvement rate（χ2=2.319, P=0.044）. Conclusion：It＇s important to identify the clinical characteristics of serious type of hand-foot-and-mouth disease timely;an active intervention treatment can reduce the mortality of hand-foot-and-mouth disease.