手足口病685例临床特点分析

目的探讨手足口病临床特点,以供临床参考。方法回顾性总结2012年3月—2012年7月本院685例手足口病患者的临床资料,分析其临床症状、体征、实验室检查、免疫学检测、病原学检测、影像学检查、临床分类、治疗方法及转归的特点。结果 685例患者临床症状以发热(58.0%)、皮疹(100.0%)、流延(89.4%)、口痛(45.4%)等为主;体征以精神萎靡(25.5%)、嗜睡(6.6%)等为主。外周血白细胞计数、心肌酶谱、脑脊液异常率分别为26.7%、10.7%、12.4%;EV71-IgM、EV71核酸阳性率分别为35.5%、60.0%;胸片、头颅及脊髓MRI异常率分别为0.3%、4.5%。临床分型为普通86.1%、重型13.4%、危重型0.4%。治疗后死亡2例,683例痊愈。结论手足口病多发生在学龄前儿童,尤其是婴幼儿;普通型患者居多,部分可出现神经系统并发症而发展成重型,少数可进展为危重型出现神经源性肺水肿、呼吸衰竭、循环衰竭危及生命。早期识别重型病例和及早正确干预是减少危重型患者、降低死亡率的关键。

Analysis of clinical characteristics of 685 patients with hand-foot-and-mouth disease

Objective To explore the clinical characteristics of hand-foot-and-mouth disease(HFMD) for clinical reference.Methods The clinical data of 685 patients with HFMF from March to July 2012 in our hospital were retrospectively analyzed in terms of clinical symptoms,physical signs,laboratory,immunological,etiological,imageological examinations,clinical types,therapy and prognosis.Results The main clinical symptoms were fever(58.0%),rash(100.0%),hydrostomia(89.4%) and stomalgia(45.4%).The main physical signs were mental fatigue(25.5%) and somnolence(6.6%).The abnormal rates of WBC,myocardial enzymes,CSF were 26.7%,10.7% and 12.4%,retrospectively.The positive rates of EV71-IgM,EV71 nucleic acid were 35.5% and 60.0%,retrospectively.The abnormal rates of chest radiography,skull and pinal cord MRI were 0.3% and 4.5%,retrospectively.The clinical types were common(86.1%),severe(13.4%),and critical(0.4%).There were 2 death cases and 683 recovery cases.Conclusion The HFMD is commonly seen in preschool children,especially in infants.Most of them are common types,part of them can have neurological complications and develop into severe types,and a small number of them can develop into critical types and have life-threatening neurogenic pulmonary edema,respiratory failure and circulation failure.Identifying severe cases and performing correct intervention at an early stage is the key to reduce the number of critical cases and mortality.