58例儿童重症手足口病的早期识别与治疗措施临床研究

Clinical study of early identification and treatment measures of severe hand-foot-mouth disease in 58 children

目的识别儿童重症手足口病的早期表现,研究其治疗措施。方法对58例重症手足口病患儿的临床资料进行回顾性分析。结果 58例患儿,明确接触手足口病患儿35例,接触史不详者18例,既往曾患过手足口病者5例。全部病例均有发热,体温在37.5~40.2℃之间,明显皮疹或疱疹51例,隐约可见皮疹7例。白细胞(WBC)计数(4~10)×10~9/L 23例,(10~20)×10~9/L 25例,>20×10~9/L 10例。肠道病毒71型(EV71)抗体阳性44例,柯萨奇病毒A组16型(Cox A16)抗体阳性10例,两者均阴性4例。血糖>8.3 mmol/L 15例,3.9~8.3 mmol/L 43例。肝肾功能正常者40例,谷草转氨酶轻度升高13例,心电图正常35例,窦性心动过速或ST-T改变者10例,合并支气管肺炎者6例,脑电图异常者9例,脑脊液异常者6例,头颅CT异常者3例。识别筛出的58例早期重症手足口病患儿经严密监护,抗病毒、应用丙种球蛋白及糖皮质激素、对症支持等综合治疗,疗程7~10 d,全部痊愈出院,无死亡病例。结论早期重症手足口病在严密监护下,早期识别筛出,早期诊断,经积极治疗,是可控、可防、可治的。

Objective To identify the early manifestation of severe hand-foot-mouth disease,and study its treatment measures.Methods Clinical data of 58 severe hand-foot-mouth disease children were retrospectively analyzed.Results Among 58 children,there were 35 hand-foot-mouth disease cases with clear contact,18 cases with unknown contact history and 5 cases with hand-foot-mouth disease history.All cases had fever,the body temperature was between 37.5～40.2℃.There were 51 cases with obvious rash or herpes,and 7 cases with vaguely visible rash.There were 23 cases with white blood cell（WBC） count as（4～10）×10^9/L,25 cases as（10～20）×10^9/L,and 10 cases as 20×10^9/L.Enterovirus 71（EV71） antibodies were positive in 44 cases,and coxsackievirus A 16（Cox A16） antibodies were positive in 10 cases,both were negative in 4 cases.There were 15 cases with blood glucose 8.3 mmol/L and 43 cases in 3.9 ～ 8.3 mmol/L.There were 40 normal liver and kidney function cases,13 aspartate aminotransferase slightly increased cases,35 normal electrocardiogram cases,10 sinus tachycardia or ST-T change cases,6 bronchial pneumonia cases,9 abnormal electrocardiogram cases,6 abnormal cerebrospinal fluid cases,and 3 abnormal brain CT cases.After comprehensive therapy of intensive care,antiviral,globulin and glucocorticoid,symptomatic and supportive treatment for 7～10 d,58 cases of early screening of children with severe hand-foot-mouth disease all cured and discharged,no death cases.Conclusion Early severe hand-foot-mouth disease,under strict supervision,early identification and screening,early diagnosis and active treatment,is controllable,preventable and treatable.