重症手足口病156例临床分析

目的:分析2010年陕西地区重症手足口病(HFMD)的临床特点,探讨其病原、高危因素及有效治疗方法。方法:对156例重症HFMD患儿的临床资料进行回顾性分析。结果:156例重症HFMD,EV71感染占75.2%。临床特点:皮疹,持续发热,精神差、易惊,嗜睡,肢体抖动,部分伴呼吸心率增快,末梢循环不良;外周血中白细胞及CRP升高,高血糖。积极给予降颅压、静脉用丙种球蛋白冲击,激素等对症治疗,临床痊愈出院119例,遗留有肢体活动障碍后遗症者29例,死亡8例。结论:陕西地区重症HFMD多为EV71感染,均合并神经系统损害,尽早应用丙种球蛋白及糖皮质激素可有效防治病情进展。出现神经系统受累时需注意神经源性肺水肿及心脏损害,早期机械通气,积极改善循环功能状态可改善预后。

The clinical analysis of 156 cases of HFMD in Shaanxi area in 2010

Objective:To analyze the clinical features of HFMD in 2010 in Shaanxi area and study the causes of the disease and the facts to get affected and seek out the effective treatments.Methods:Are reviewing the records of 156 children patients with serious conditions hospitalized by our hospital from Shaanxi area during 2010.4-2010were analysed.10.Results:We used rRT-PCR to examine the 156 cases of severely sick children finding 75.2% of them got affected by EV71;Including skin rash the typical clinical features mostly happened to patients bellow 3 years old,who often suffered from continuous fever,fatigue,easy to be frightened,uncontrolled shaking.Part of them also appeared increasing breathing rate and peripheral circulation disturbance,white cell and CRP increasing in peripheral blood and high level of blood sugar.After treatment of releasing intracranial pressure and large amount of IVIG injection and hormonal drugs,119 patients cured from hospital with 29 cases suffered from aftereffects of disorder of body motions and 8 cases of death.Conclusion:the severe cases of HFMD in Shaanxi area are mostly caused by EV71 affection and all have the damage of nerve system.An early use of IVIG and glucocorticoid can effectively prevent the disease from developing.When damage appears on nerve system,we need pay attention to pulmonary edema and damage to heart.An early stage of treatment such as mechanical ventilation and active improvement of circulation can help thereafter.