重症手足口病100例临床特点及救治措施分析

Clinical characteristics and treatment measures of 100 cases of severe hand,foot and mouth disease

目的分析重症手足口病临床特点及救治措施。方法分析西安市儿童医院2013年1月至2014年9月收治的100例重症手足口病患儿的临床资料,依据病情严重程度将患儿分为研究组和对照组各50例,研究组患儿病情较为严重,对照组患儿病情相对较轻;经治疗后,比较综合治疗和常规治疗措施的效果。结果重症手足口病患儿临床表现为发热、易惊或四肢抖动、惊厥或昏迷、皮肤花纹状、四肢末梢凉、收缩压>130mm Hg、心率>130次/min,甚至有呼吸节律不整、点头样呼吸等症状,需要进行气管插管机械通气治疗。实验室检查中,研究组患儿白细胞计数(WBC)、血糖、乳酸水平均显著高于对照组(t值分别为8.316、9.457、6.769,均P<0.05),但两组患儿的二氧化碳总量(TCO2)、肌酸激酶同工酶(CK-MB)水平之间差异均无统计学意义(均P>0.05);研究组患儿治疗后的呼吸和心率均显著低于对照组(t值分别为15.971、28.653,均P<0.05),治疗的总有效率(96.0%)显著高于对照组(76.0%),χ2=12.753,P<0.05,治疗后的不良反应发生率(6.0%)显著低于对照组(20.0%),χ2=15.117,P<0.05。结论重症手足口病的病情进展能够在易惊或四肢抖动、惊厥或昏迷、皮肤花纹状、四肢末梢凉、收缩压>130mm Hg、心率>130次/分、发生率、发热时间,以及WBC、血糖、乳酸水平升高中得到有效预测。综合治疗较常规治疗效果显著。

Objective To analyze the clinical characteristics and treatment measures of severe hand, foot and mouth disease （HFMD）. Methods Clinical materials of 100 cases of severe HFMD were analyzed. All those cases received treatments at Xi＇ an Children＇ s Hospital from January 2013 to September 2014. These patients were divided into study group and control group according to the severity of disease. Patients in the study group had severer conditions than those of the control group. After treatment, effects of comprehensive treatment and conventional treatment were compared. Results Clinical manifestations of severe HFMD included fever, hyperarousal or trembling limbs, convulsions or coma, pattern-like skin, coldness of four extremities, systolic pressure 〉 130mmHg and heart rate 〉 130beat/rain. Moreover, patients with HFMD even suffered from respiratory dysrhythmia and nodding respiration and needed to be treated by intubation and mechanical ventilation. Results of laboratory examination showed that patients in the study group had significantly higher levels of white blood cell count （WBC）, blood glucose, and lactic acid than those of the control group （t value was 8. 316, 9. 457, and 6. 769, respectively, all P 〈 0.05 ）. There was no statistically significant difference （ all P 〉 0.05 ） between two groups in total carbon dioxide （TCO2） and creatine kinase-isoenzyme MB （CK-MB）. After treatment, the respiratory rate and heart rate in patients of the study group were remarkably lower than those of the control group （ t value was 15. 971 and 28. 653, respectively, both P 〈 0.05 ）. The overall effective rate （96.0%） in the study group was significantly higher than that （76.0%） in the control group （X2 = 12. 753, P 〈0.05）. The incidence rate of adverse reactions after treatment in the study group （ 6.0% ） was significantly lower than that of the control group （20.0%） （X2 = 15. 117, P 〈 0.05 ）. Conclusion The progression of severe HFMD can be effectively predicted by symptoms like hyperarousal or trembling limbs, convulsions or coma, pattern-like skin, coldness of four extremities, systolic pressure 〉 130mmHg and heart rate 〉 130beat/min, incidence rate, timing of fever and increase of WBC, blood glucose as well as lactic acid. The comprehensive treatment is more effective than conventional treatment.