儿童重症手足口病52例

52 cases of children's severe hand-foot and mouth disease

目的 探讨儿童重症手足口病的临床特点、治疗方法及预后.方法 选择2008年5月～2011年12月杭州市余杭区妇幼保健院收治的重症手足口病患儿52例,根据有无神经系统和其他并发症及其程度,将其分为A组25例、B组15例、C组9例、D组3例,其中A组为非神经系统受累组,B组、C组、D组合并为神经系统受累组（27例）.各组分别给予不同的治疗方案,分析总结各组疗效及预后.结果 52例中出现发热52例（100.00％）,皮疹51例（98.08％）.21例伴白细胞（WBC）计数增高,16例CRP升高,11例血糖升高,15例血压升高.脑脊液异常20例.52例均做大便EV71及CoxA 16的RT-PCR定性核酸检测,EV71阳性28例,CoxA 16阳性8例,其中EV71和CoxA 16均阳性3例.神经系统受累组与非神经系统受累组EV71阳性率比较,差异有统计学意义（x2=4.22,P＜0.05）.A、B、C组共49例,全部治愈.D组3例,死亡2例,1例抢救成功,无后遗症.结论 重症手足口病主要发生在3岁以下幼儿,高热、皮疹稀少是其主要临床特点,早期诊断、早期治疗,大多数预后良好.神经系统受累的重症病例,及时合理使用甘露醇、甲强龙、丙种球蛋白以及其他对症支持治疗,可能对阻止重症病例向危重状态发展和降低危重症病死率有益.

Objective To explore clinical characteristics,treatment and prognosis of pediatric severe hand-foot and mouth disease （HFMD）.Methods 52 cases with severe HFMD patients from May 2008 to December 2011 in Maternal and Child Care Service Centre of Yuhang District in Hangzhou City were selected and divided into group A with 25 cases,group B with 15 cases,group C with 9 cases,group D with 3 cases according to the neurological complications and other complications and degree.Group A was the non-nervous system involvement group; group B,group C,group D were combined as nervous system involvement group （27 cases）.Each group was given a different treatment plan,the effect and the prognosis were analyzed and summarized.Results 52 cases （100.00%） with fever,51 cases （98.08%） with rash were found.21 cases with WBC count rise,16 cases with CRP rise,11 cases with high blood sugar,15 cases with high blood pressure were found.20 cases of abnormal cerebrospinal fluid were found.hit EV71 and CoxA 16 RT-PCR qualitative nucleic acid test was carried out in 52 cases,28 patients with EV71 positive,8 cases with CoxA 16 positive were found,3 cases with EV71 and CoxA 16 combined positive were found.The difference of EV71 positive rate between the non-nervous system involvement group and nervous system involvement group was statistically significant （x2=4.22,P 〈 0.05）.49 cases of group A,B and C were all cured.2 cases died and 1 case of successful rescue without sequelae were found in group D.Conclusion Severe HFMD mainly in children under the age of 3,and the continuous fever rash rare is its main characteristics,early diagnosis and early treatment,most prognosis are good.The nervous system involvement of severe cases,timely reasonable use mannitol,methylprednisolone,IVIG and breathing machine treatment,and may prevent severe cases of serious state development and enhance the rate of successful rescue inpatients with nervous system involvement.