手足口病并脑炎126例临床特点及神经心理发育随访

A follow up study and characteristics of 126 cases with hand-foot-mouth disease complicated by encephalitis

目的 分析手足口病（HFMD）并脑炎儿童的临床特征及小儿神经心理发育评分,探讨HFMD对儿童智能的影响及其恢复结果 。方法 回顾分析2008年1月—2012年6月住院的126例HFMD合并脑炎患儿的临床资料及出院后随访资料,采用Gesell发育量表进行测试并与同年龄正常儿童作对比。结果 发热126例、惊厥9例,易惊51例、肢体抖动82例、呕吐32例、脑干脑炎合并神经源性肺水肿24例,单纯肺水肿22例,转归：死亡8例,肢体无力8例,吞咽功能障碍27例,咳嗽功能障碍24例,肢体瘫痪2例,面瘫1例,眼肌麻痹2例,长期呼吸机依赖1例。101例出院前神经心理发育评分显示大动作、精细动作、发育商低于同年龄正常儿童,差异有统计学意义（P〈0.05）。87例患者1~3年随访结果 ：大动作、精细动作、发育商明显改善（P〈0.05）,轻度肢体运动障碍5例、颅神经损害患者均恢复正常。结论 HFMD并脑炎的神经受累特点是弛缓性麻痹,大动作、精细动作、发育商受影响,但大部分病例都可以完全康复,预后比较好。

Objective To study clinical characteristics and follow up the result of Hand-foot-mouth disease （HFMD） children complicated by encephalitis. Methods A total of 126 HFMD patients complicated with encephalitis, diagnosed from Jan. 2008 to June 2012 ,were retrorespectively analyzed,nervous systemic examination and intelligence development were regularly tested by Gesell Developmental Scale（GDS） after discharge. The results were compared with those of the same age children. Results The clinical characteristics were as following： fever （ 126 cases, ）, convulsion （ 9 cases ）, vomiting （ 32 cases）, startling（ 51 cases ）, jarring （ 82 cases）, brainstem encephalitis and neurogenic pulmonary edema （ 24 cases）, simple pulmonary edema（22 cases）. Turnover： death in 8 cases, limb weakness in 8 cases, dysphagia in 27cases, cough suppression in 24 cases, ophthalmoplegia in 2 cases,limb weakness in 2 cases, facial paralysis in 1 case , long term me- chanical ventilation in 1 case. Physical development and Development Quotient（DQ） ：the HFMD patient were lower than normal children in DQ and activities（ P 〈 0.05 ） . The results of following up in 87cases ： mild limb weakness in 5 cases , normal DQ in 80 cases , cranial nerve deficit remedied completely in all patients. Conclusion The clinical features of HFMD were flaccid paralysis, DQ, cranial nerve and activities were commonly affected, but most of the symptoms would improve soundly, good prognosis was expected.