危重型手足口病15例临床分析

Analysis of the Clinical Data of 15 Patients with Serious Hand-foot-mouth Disease

目的：分析总结15例重症危重型手足口病患儿的临床特征。方法：回顾性分析2010年5月-2013年7月本院儿科住院的15例重症危重型手足口病患儿的临床资料。结果：（1）15例患者中，男12例，女3例；发病年龄6-52个月：其中≤1岁者4例，1-3岁者9例，3-5岁者2例，平均21个月。治愈好转11例，死亡4例（26.7%）。（2）15例危重型患儿在起病0-3 d内以精神萎靡、呕吐、惊跳为主要临床特征，发生率分别为100%、73.0%、86.7%；在起病3-5 d内以循环功能障碍、呼吸功能障碍、抽搐、死亡为主要病情改变，发生率分别是85.7%、42.9%、50.0%、21.4%。（3）死亡组白细胞计数、嗜中性粒细胞比率、血糖水平，死亡组均明显高于存活组，比较差异均有统计学意义（P〈0.05）；死亡组C反应蛋白、肝功能、心肌酶检查改变不明显（P〉0.05）。结论：危重型手足口病患儿病情进展迅猛，死亡率高。精神萎靡、呕吐、惊跳是危重型手足口病早期主要临床表现，可作为早期迅速判断危重病情的指标；白细胞计数、嗜中性粒细胞比率、血糖水平异常增高提示患儿死亡风险高。

Objective：To analyze and summarize the clinical features of 15 children who suffered from serious hand-food-mouth disease（HFMD）. Method：Clinical data of 15 hospitalized children with serious hand-food-mouth disease（HFMD）in our hospital from May 2010 to July 2013 were analyzed retrospectively.Result：（1）In 15 patients,had 12 males and 3 females;age at onset：from 6 months to 52 months：there were 4 cases≤1 year old,9 cases whose age were 1-3 years old,2 cases of 3-5 years old,the average age was 21 months.11 cases were cured,4 cases died（26.7%）. （2）Fifteen children who were critically ill began to present listlessness,vomiting,startle as their main clinical features during onset time of 0-3 days, the occurrence rates were 100%,73.0%,86.7%;During the onset time of 3-5 days,the main transformations of illness were convulsions,respiratory dysfunction,circulatory dysfunction and death,transformation rates were 85.7%,42.9%,50.0%,21.4%.（3）In terms of white blood cell count, neutrophil percentage and blood glucose level,the death group was higher than the survival group,the differences were statistically significant（P〈0.05）;The changes of C-reactive protein,liver function and myocardial enzymes in the death group were not significant（P〉0.05）.Conclusion：The state of illness of serious HFMD progress rapidly,the mortality rate is high.Listlessness,vomiting,startle are the main clinical manifestations in the early days of HFMD,which could be considered as indicators to judge serious HFMD early and quickly;the dramatic increase of white blood cell count,neutrophil percentage and blood glucose levels indicate that children may be in the high risk of death.