中医药辨证治疗重症手足口病并发中枢神经系统损害30例

30 Cases of Dialectical Synthesis of Chinese Medicine on Severe Cases Hand-foot-mouth Disease with Complication of Central Nervous System Damage

目的:探讨中医药辨证治疗重症手足口病并发中枢神经系统损害的临床疗效及脑脊液神经元特异性烯醇酶(NSE)的影响。方法:将60例患儿随机按数字表分为对照组和观察组各30例。对照组参照《手足口病诊疗指南(2010版)》及"专家共识"进行对症、支持处理。观察组在对照组基础上采用古方羚角钩藤汤联合菖蒲郁金汤辨证加减治疗。两组疗程均为10 d。记录治疗后3 d内体温恢复正常、血象、血糖恢复正常,易惊和肢体震颤消失及精神状况改善例数,记录皮疹、疱疹消退时间,口腔溃疡愈合时间;监测血常规和血糖;于治疗第0,5,10天行脑脊液检测常规及生化检测,并检测NSE。结果:治疗后3 d内观察组体温、血象、血糖恢复正常例数多于对照组(P<0.05);观察组体温复常时间,易惊消失时间,肢体震颤消失时间、皮疹,疱疹消退时间,口腔溃疡愈合时间,血象、血糖及脑脊液复常时间均优于对照组(P<0.01);观察组总有效率为93.3%,优于对照组的73.3%(P<0.05);治疗后第5、10天两组脑脊液NSE和白蛋白水平均较治疗前下降(P<0.01),观察组在第5,10天脑脊液NSE和白蛋白水平低于对照组(P<0.05或P<0.01)。结论:在西医常规对症、支持治疗的基础上采用中医药辨证治疗重症手足口病并发中枢神经系统损害患儿,能快速控制患儿症状、体征,缩短了病程,保护了患儿神经功能,提高了临床疗效。

Objective： To observe clinical effects of dialectical synthesis of Chinese medicine on severe cases hand-foot-mouth disease with complication of central nervous system damage and the influence of dialectical synthesis of Chinese medicine on neuron specific enolase （NSE）. Method： Sixty subjects were randomly divided into observation group （ n = 30） and control group （ n = 30）. Both groups were treated according to 〈 diagnosis and treatment guidelines of hand-foot-mouth disease （2010） 〉 and ＇ expert consensus＇. Observation group were given ancient medicine Lingjiao Gouteng decoction and Changpu Yujin decoction on the basis of control group, for 10 days. The cases of body temperature returned to normal, blood picture back to normal, blood sugar back to normal, tremors disappear and mental health improvement in 3 days were recorded. The disappearing time of erythra, herpes and oral cavity ulcer healing time were recorded. Blood routine examination and blood glucose were monitored. Conventional and biochemical tests of cerebrospinal fluid and neuron specific enolase （NSE） test were proceeded in 0, 5, 10 days. Result： The cases of body temperature, blood picture, blood sugar back to normal in observation group were more than control group （P 〈 0.05）. Temperature returned to normal time, skittishness and tremors disappearing time, erythra, herpes disappearing time, oral cavity ulcer healing time and hemogram, blood glucose, cerebrospinal fluid returned to normal time in observation group were superior to control group （P 〈 0.01 ）. The total effective rate of observation group （93.3%） was superior to control group （73.3%） （ P 〈 0.05）. The level of NSE and albumin in 5, 10 days of both groups were declined than before （P 〈 0.01） , the level of NSE and albumin in observation. Conclusion： The application of dialectical synthesis of Chinese medicine on patients with severe cases hand-foot-mouth disease with complication of central nervous system damage on the basis of conventional western medicine treatment can split-second control symptoms and signs of children, shorten the course of the disease, protect the children neural function, improve the clinical efficacy of therapy and it is worth using.