重症手足口病致死机制及其防治的研究进展

Research Progress on the Death Mechanism and Prevention of Severe Hand Foot and Mouth Disease

近年来重症手足口病病死率虽有明显下降,但仍时有报道。其致死原因主要为病毒感染触发自主神经功能障碍,导致神经-内分泌-免疫网络紊乱,从而发生神经源性肺水肿和循环衰竭。治疗方法除抗病毒、对症、生命支持等外,对出现危重表现的患儿可早期给予免疫球蛋白和酌情使用糖皮质激素,可尝试血液滤过疗法,对治疗无反应的患儿可借助体外膜肺技术来挽救患儿生命。手足口病流行地区的易感儿童可提前进行肠道病毒71型疫苗的预防接种,减少重症及死亡病例的发生。

Although the mortality of HFMD(Hand, foot and mouth disease) has decreased significantly in recent years,it is still reported from time to time.At present, most studies believe that the cause of death is mainly caused by the virus infection triggering the dysfunction of autonomic nervous system,leading to the disorder of nerve-endocrine-immune network,resulting in neurogenic pulmonary edema and circulatory failure.In addition to antiviral therapy,symptomatic therapy and life support,early immunoglobulin and appropriate glucocorticoid can be given to children with critical illness.Hemofiltration can be tried.Those non-responding to regular treatments could be saved with extracorporeal membrane oxygenation technology.It′s proposed that children under HFMD endemic areas should be inoculated with enterovirus 71 vaccine in adva nce to reduce the incidence of severe and death.