重症手足口病155例临床特点分析

The clinical feature of severe hand-foot-mouth disease in 155 cases

目的：探讨重症手足口病患儿的临床特点及治疗体会。方法：对155例重症手足口病患儿的相关临床流行病学资料进行回顾分析，患儿在抗感染及对症治疗基础上，均给予静脉注射丙种球蛋白、甲泼尼龙，根据病情给予降颅压、改善循环、营养心肌、呼吸支持等综合治疗。结果：155例重症患儿多发生在3岁以内（91．6％），其中1～2岁占60．6％；以男孩多见，男女比例1．5：1；农村患儿121例（72．2％）；均有易惊、皮疹，其中发热147例，嗜睡、精神差110例，肢体抖动32例，恶心呕吐14例，出冷汗3例。血常规WBC升高75例，肌酸激酶同工酶升高68例，血糖升高45例，C反应蛋白升高37例，血压升高33例，心率增快16例。150例患儿行脑脊液检查，其中异常148例。治愈153例，其中1例曾出现急性迟缓性麻痹；2例死亡。结论：针对临床手足1：1病患儿尤其是年龄〈3岁，伴有发热、嗜睡、打惊等精神症状者，高度重视，密切观察血压、血糖、心率等生命体征变化，早期识别重症手足口病，早期干预治疗是降低病死率、减少后遗症、改善患儿预后的关键。

Objective： To explore the clinical features and treatment experience of severe hand-foot-mouth disease in children. Methods：The clinical data of 155 children with severe hand-foot-mouth disease were retrospectively analyzed. All patients were treated with intravenous gamma globulin, methylprednisolone based on anti-infection and symptomatic treatment, and reducing intracranial pressure, improving circulation and myocardium and supporting respiratory according to patient＇s condition. Results： Amony 155 patients,the severe hand-foot-mouth disease tended to occur in children less than 3 years old（91.6% ）, 1 to 2 years old children accounted for 60.6%. The ratio of boy to girl was 1.5 to 1 ,the rural children were 121 cases（72.2% ）. The skittishness and rash in all patients were found. The fever in 147 cases, lethargy and poor spirit in 110 cases, limb jitter in 32 cases, nausea and vomiting in 14 cases,cold sweat in 3 cases, WBC rising in 75 cases, creatine kinase isoenzyme rising in 68 cases, blood sugar rising in 45 cases, C reactive protein rising in 37 cases, high blood pressure rising 33 cases and heart rate increasing in 16 cases were found. The abnormal cerebrospinal fluid in 148 cases was found by examination. One hundred and fifty-three patients including 1 case with acute flaccid paralysis were cured,2 cases died. Conclusions：The severe hand-foot-mouth disease often occurs in children less than 3 years old, the blood pressure,blood sugar, heart rate of vital signs in children with fever, lethargy and shock psychiatric symptoms should be closely observed. The early diagnosis and intervention are the key to reduce the mortality rate and sequela and improve the prognosis.