重症高危手足口病患儿的临床观察与救治

目的总结手足口病（HFMD）重症高危患儿的临床特点及治疗方案。方法回顾性分析2009年4月～2011年8月东莞市石龙人民医院3693例HFMD患儿的临床资料，根据疾病严重程度将其分为普通组3608例．重症组85例。比较两组患儿临床表现、实验室检查及治疗效果。结果HFMD高危重症患儿病情较重，更易惊厥和（或）昏迷，皮肤四肢末梢较凉，皮肤多呈花纹状，其发热病程更久，血压及心率较普通HFMD高；普通组白细胞（WBC）[（9．32＋3．01）×10^9／L]、血糖[（7．00±2．98）mmol／L]及乳酸水平[（1．81±0．82）mmol／L]均低于重症组[（10．14±3．65）×1091L、（8．51±4．71）mmol／L、（2．29±1．82）mmol／L]，差异均有统计学意义（t=2．678、4．301、3．582，P=0．0245、0．0096、0．0248）；普通组总有效率为96．4％，明显高于重症组（81．2％），差异有高度统计学意义（x^2=49．225，P＜0．01）。结论HFMD重症高危患儿病情发展迅速，血糖、血压、WBC均升高，神经系统、呼吸系统及循环系统均受到影响，故临床上应当积极干预，阻止疾病向重症发展。

Clinical observation and treatment for severe children with hand-footmouth disease

Objective To discuss the clinical characteristics and treatment options of the hand-foot-mouth disease （HFMD）. Methods 160 children with HFMD from April 2009 to August 2011 in Shilong Dongguan People＇s Hospital of Dongguan City were retrospectively analyzed. All the cases were divided into two groups according to the severity of disease, 54 cases in the normal group, 106 cases in the serious group. The clinical manifestations, laboratory results and treatment effect of the two groups were compared. Results The serious children with heavier, more convulsion and coma, skin limbs endings cooler, and more decorative pattern, the heating duration longer, showed a high blood pressure and heart rate than ordinary HFMD. The WBC, blood sugar, lactic acid levels of serious group were （9.32±3.01）×109/L, （7.00±2.98） mmol/L, （1.81±0.82） mmol/L respectively, lower than those of the normal group [（10.14±3.65）×10^9/L, （8.51±4.71） mmol/L, （2.29±1.82） mmol/L], the differences were statistically significant （t = 2.678, 4.301, 3.582; P = 0.0245, 0.0096, 0.0248）. The total effective rate of the normal group was 96.4%, higher than that of the serious group （81.2%）, the difference was statistically significant （X^2=49.225, P 〈0.001）. Conclusion The children with severe HFMD should actively intervention, give active intervention, prevent disease to intensive development