开封市102例手足口病临床表现及就诊情况调查

目的探讨重症、轻症手足口病临床表现及就诊过程中的影响因素,为手足口病防控、管理提供科学依据。方法单纯随机抽取开封市102例手足口病病例开展病案和电话调查,对病人的临床表现及就诊情况进行分析。结果手足口病临床表现以发热（78.43%）、出疹（99.02%）多见;57.84%可见精神差、惊颤、呕吐、咳嗽等其他症状;37.25%出现病毒性脑炎、支气管炎等并发症和合并症。重症与轻症病例相比最高体温较高（t=3.86,P〈0.05）、先发热后出疹的较多（χ2=4.96,P〈0.05）、可见嗜睡、肢体肌阵挛等特有症状且出现较晚,首诊不易确诊（χ2=12.77,P〈0.05）。首诊医院中,县及县以下医院就诊率重症高于轻症（χ2=16.32,P〈0.05）,但确诊率重症低于轻症（χ2=5.27,P〈0.05）。结论本研究结果表明,重症手足口病病例早期症状不典型,县及县以下基层医院易误诊。建议开展基层医务人员手足口病诊治技术培训,提高对手足口病的诊断鉴别能力。

Analysis on clinical manifestations and diagnosis of 102 patients with hand-foot-mouth disease in Kaifeng city

Objective To analyze the clinical symptoms and the diagnosis of patients with hand-foot-mouth disease（HFMD）in Kaifent city,and to provide basis for prevention and control of HFMD. Methods One hundred and two patients with HFMD were randomly selected from Kaifeng city.The medical record data were collected and a telephone survey was conducted on the patients.The patients′ main clinical symptoms and diagnostic situation were analyzed. Results Fever and herpes occurred in 78.43% and 99.02% of the patients with HFMD;57.84% of the patients had the symptoms of lassitude,vomit and cough;37.25% of the patients had complications of viral encephalitis or bronchitis.The body temperature of patients with severe HFMD was higher than that of patients with mild HFMD（t =3.86,P 0.05）.Many patients had fever as their first clinical sign,followed by rash（χ 2=4.96,P 0.05）.The patients with lately developed symptoms such as sleepiness,myoclonic jerks were difficult to be diagnosed as HFMD at their first hospital visit.More patients with severe HFMD firstly visited a county level（or lowere level）hospital（χ 2=16.32,P 0.05）.The correct diagnosis rate was higher in patients with mild HFMD than that in patients with severe HFMD. Conclusion The patients with severe HFMD often have atypical early symptoms,which are easily misdiagnosed by county level（or lower level）hospital,and thus miss the best treatment opportunity.It is recommended that technical training on HFMD be carried out in doctors of county level（or lower level）hospital to improve their diagnostic ability of HFMD.