具有高血压表现的危重型手足口病636例诊治分析

Analysis of the diagnosis and treatment of 636 critical hand foot and mouth with hypertension

目的：总结危重型手足口病（ HFMD）临床诊治经验及病原学分析。方法选择636例危重型手足口病患儿，均给予并发脑炎的常规治疗。本研究患儿均出现高血压，624例给予静脉滴注酚妥拉明8～20μg/（ kg·min），其中143例高血压仍未控制，改用静脉滴注硝普钠，血压稳定后逐渐减量至停药。46例呼吸、循环衰竭患儿（其中20例神经源性肺水肿、肺出血）在入院12 h内应用机械辅助通气。结果未给予降压治疗的12例危重型HFMD患儿机械通气治疗11例，5例（41.67%）死于肺出血；2例病情好转出院，后失访。624例危重型HFMD患儿及时给予治疗、控制高血压，机械通气治疗35例，7例死于肺出血，2例好转出院后失访。631例做粪便病原检测：其中EV71阳性495例。结论目前 HFMD 己成为儿科较常见、危害儿童健康的重要肠道传染病，危重型HFMD病原以EV71为主。本研究患儿均出现高血压，高血压严重程度与肺水肿成正比。本研究624例在治疗脑炎的同时积极治疗控制高血压，明显减少了机械通气的应用及静脉丙种球蛋白的应用，降低了医疗成本，取得了满意疗效。重视及尽早发现、及时治疗控制高血压是抢救危重型HFMD患儿最重要措施之一，是最大限度降低危重型 HFMD患儿病死率、致残率的关键。

Objective To summarize the experience of diagnosis and treatment of critical hand foot and mouth disease（ HFMD）and pathogen analysis. Methods The 636 cases of critical hand foot and mouth disease were chosen,and all cases were given conventional treatment for encephalitis. All of the patients had hypertension,624 patients were treated with intravenous injection of phentolamine 8 -20 μg/（ kg·min）,including 143 cases of uncontrolled hypertension,and were given intravenous sodium nitroprusside,the dosages gradually reduced to withdrawal after the blood pressure was steady. Forty-six cases of respiratory and circulatory failure（ including 20 cases of neurogenic pulmonary edema,pulmonary hemorrhage）were given mechanical ventilation within 12 hours of admission. Results Among the 12 cases without antihypertensive treatment, 11 cases were given mechanical ventilation, 5 cases（ 41 . 67%） died of pulmonary hemor-rhage,2 cases improved and lost follow-up. The 624 cases of critical HFMD were given antihypertensive therapy and control of hypertension,35 cases were given mechanical ventilation,7 cases died of pulmo-nary hemorrhage,2 cases improved and lost follow-up. 631 cases had fecal pathogens detection：495 ca-ses with positive EV71. Conclusions HFMD is an important infectious disease in pediatrics,it made serious harm to the health of children. EV71 infection is the main reason which caused critical cases. All cases had hypertension,and the severity of hypertension is proportional to the severity of HFMD. The 624 cases were given the treatment of encephalitis at the same time of active treatment of hypertension,signifi-cantly reduced the application of intravenous immunoglobulin and mechanical ventilation,reduced the cost of medical care,obtained satisfactory curative effect. Attention and early detection,timely treatment and control of hypertension is the most important measures for rescue critical HFMD and minimize the mortality and morbidity of critical HFMD.