儿童危重症手足口病43例临床特点分析

目的探讨危重症手足口病患儿的临床特点。方法回顾分析43例危重症手足口病患儿的临床症状、体征、血常规、血生化、胸片、心电图、头颅MRI或CT、EEG、BAEP检查的结果及治疗效果。结果危重症手足口病临床特征：患儿年龄多在3岁以下，发热以高热为主；最常出现的神经系统表现有肢体震颤、精神差、烦躁、惊跳；还可出现血糖升高、肺水肿、肺出血等；脑干听觉诱发电位检查和头颅MRI检查可表现异常；除常规治疗外，40例需行气管插管呼吸机机械通气，38例治愈或好转出院，随访1年，未发现明显的智力落后、继发性癫痫及肢体瘫痪。4例死亡，1例家人放弃治疗，撤离呼吸机机械通气后死亡。结论及早识别危重症手足口病患儿的高危因素、早期干预治疗是减少后遗症、降低病死率、改善患儿预后的关键。脑干听觉诱发电位可作为筛选脑干是否受损的一种常规检查手段。

Clinical analysis of 43 children with severe hand foot and mouth disease

Objective To explore the clinical features of children with severe hand, foot and mouth disease （HFMD）. Methods The symptoms, signs and prognosis in 43 children with severe HFMD were reviewed retrospectively. 43 patients were studied by blood routine examination, blood biochemical criterion, chest X-ray, EKG, MRI/CT, TCD, EEG and BAEP as the combined diagnostic methods. Results Clinical feature of the severe HFMD cases included ： the majority of sick chileren were younger than 3 years old, who had high fever and presented typical rash. The major symptoms of neurological complication included limb tremor, fatigue, restlessness and irritation. The other clinical feature included the blood glucose level of more than 6 mmol/L and the chest X-ray showed pulmonary edema or pneumorrhagia. BAEP or head MRI showed abnormalities in partial cases. Except for the routine methods. 40 cases had been treated by respirator with tracheal intubation. In all the 43 cases, 38 cases recovered well, who had no sequelae observed in the follow-up survey for one year, 4 cases died during the treatment, and 1 case died after her parents gave up treatment. Conclusion To reduce the sequelae and death rate of this disease, it was essential to early judge the high risk factors of critical case and to take interference treatment as early as possible. BAEP was a routine examination for judging the damage of brainstem.