累及神经系统手足口病临床特征分析

Clinical characteristics of hand,foot and mouth disease with neurological involvement

目的总结分析累及神经系统手足口病(HFMD)的临床特征,为该病的诊断及早期干预治疗提供依据。方法以杭州市儿童医院收治的144例重症及危重症HFMD患儿为研究对象,对重症组及危重症组的临床特点、实验室检查结果等进行回顾性分析。将两组临床特征及实验室数据进行χ~2检验,探讨重症进展为危重症的危险因素。结果 144例中男95例,女49例,平均年龄(21.19±14.10)个月。危重症组56例,重症组88例。高热133例(92.4%),持续高热>3d 107例(74.3%),神经系统均有不同程度受累,较多出现的症状为神软(91.7%)、呕吐(75.7%)、肢体抖动(63.9%)、心率增快(60.4%)、睡眠惊跳(49.3%)、呼吸不规则(47.2%)等。在不典型皮疹、肢体无力、肢体抖动、意识障碍、瞳孔对光反射减弱、血痰、紫绀、呼吸困难、肺部湿罗音、血压异常、心率快、SpO_2<90%、肢体花纹、外周血WBC>17.5×10~9/L、BS>8.3mmol/L、EV71阳性等方面,危重症组的发生率明显高于重症组,差异有统计学意义(P<0.05)。预后:并发肺水肿、肺出血47例(32.6%),脑干脑炎36例(25.0%),循环衰竭36例(25.0%),迟缓性瘫痪16例(11.1%)。36例(25.0%)死亡,108例(75.0%)治愈出院。结论危重症HFMD主要发生在3岁以下婴幼儿,男性多于女性,首发症状为急性高热,皮疹多不典型,病原多为EV71感染,以神经系统受累为主,一旦出现肺水肿、循环衰竭治疗效果不理想,病死率高。早期发现、及时干预是降低本病病死率的关键。

Objective To understand the clinical characteristics of hand,foot and mouth disease with neurological involvement,provide theoretical reference for early diagnosis and rescue treatment of HFMD.Methods A retrospective analysis was performed based on the clinical records,laboratory data and treatment effect which were collected from144severe HFMD in the hospital.144HFMD were divided into the severe group(88cases)and the intensive care group(56cases).The difference of clinical symptoms,vital signs and laboratory data were analyzed by chi-square between the two groups.Results Of the144severe cases,95were male and49were female,the median age was(21.19±14.10)months.Fever(92.4%)was the most common symptom,107cases(74.3%)had fever for more than three days.All cases had different extent of nervous system impact.Poor spirit(91.7%),vomiting(75.7%),tremble(63.9%),tachycardia(60.4%),irritation(49.3%)and dyspnea(47.2%)were common symptoms among the cases.Incidence rate of the atypical rashes,weakness of limbs,tremble of limbs,impaired consciousness,weak pupillary light reflex,bloody sputum,cyanosis,dyspnea,moist rale in lungs,abnormal blood pressure,tachycardia,low SpO2,high WBC level,hyperglycemia,EV71infection in the intensive care group were higher than those of severe group(P<0.05).Complications included pneumonedema and pneumorrhagia(32.6%),brainstem encephalitis(25.0%),circulatory failure(25.0%)and flaccid paralysis(11.1%).After the comprehensive treatment,108cases recovered,and36cases died.Conclusion Severe HFMD patients are mostly younger than3-year-old aged boys,first symptom is acute fever,rash appeared atypical and have the nervous system damage.Pathogen mainly is EV71.The treatment effect is not ideal when pneumonedema and circulatory failure occured,and the mortality is very high.Early detection and timely treatment is very important to reduce mortality.