西部某医院484例重型手足口病临床特点分析

目的探讨重型手足口病的临床特点,以总结救治经验。方法回顾性分析我院2011年1月—2012年12月收治的484例手足口病的临床表现和治疗情况。结果本组患儿男女比为1.5∶1,年龄(2.17±0.60)岁,病程(2.74±1.19)d,住院天数(6.14±1.78)d。临床症状和体征主要有手和(或)足部皮疹(100%)、精神差(98.1%)、发热(95.7%)、惊跳(95.7%)、激惹(94.4%)、心率加快(81.8%)、呕吐(40.1%)、血压升高(36.6%)和肢体抖动(33.9%)。实验室检查异常指标主要有白细胞计数升高(60.1%)、心肌损伤(38.0%)、血糖升高(32.9%)、血乳酸升高(31.0%)。脑脊液检查为病毒性脑炎改变,脑部CT/MRI检查均未见异常。病原学检查以EV71感染为主(65.1%)。经抗病毒和对症治疗,应用静脉免疫球蛋白(intravenous immunoglobulin,IVIG)、米力农(甲氰吡酮)、甘露醇和地塞米松等治疗后,所有患儿均痊愈出院,无一例转为危重型。结论重型手足口病早期临床表现较隐匿,精神差、惊跳、激惹为神经系统最主要表现。早期诊断并及时应用甘露醇和地塞米松,血压升高时及时应用米力农,血糖和白细胞明显升高时酌情应用IVIG,则预后良好。

Clinical features of 484 patients with severe hand,foot and mouth disease in a certain hospital in Western China

Objective To investigate the clinical features of children with severe hand, foot and mouth disease （HFMD）, and summarize the experience in diagnosis and treatment of severe HFMD. Methods The clinical manifestations and treatment of 484 children with severe HFMD treated in our hospital from Jan. 2011 to Dec. 2012 were analyzed retrospectively. Results The ratio of male and female children was 1.5∶1, the average age was 2.17＆#177;0.60 years old, the average disease course was 2.74＆#177;1.19 days, and the average duration of hospitalization was 6.14＆#177;1.78 days. The main clinical signs and symptoms were rash on hand and/or foot （100%）, fatigue （98.1%）, fever （95.7%）, startling （95.7%）, irritation （94.4%）, increased heart rate （81.8%）, vomiting （40.1%）, hypertension （36.6%） and limb shaking （33.9%）. Laboratory abnormalities were abnormally elevated white blood cell count （60.1%）, myocardial injury （38.0%）, elevated blood glucose （32.9%） and elevated blood lactate （31.0%）. Cerebrospinal fluid examination showed viral en-cephalitis, but brain CT and MRI showed that no brain abnormality was found. Enterovirus 71 （65.1%） was the most common pathogen. After antiviral therapy and symptomatic treatment, such as intravenous injection of intravenous immunoglobulin （IVIG）, milrinone, man-nitol and dexamethasone, all the patients were cured and discharged, and no patient progressed to critical illness. Conclusions The early clinical features of severe HFMD are hard to detect. The typical neurological features include fatigue, startling and irritation. Early di-agnosis and treatment with mannitol and dexamethasone timely, with milrinone timely when hypertension is found and with IVIG proper-ly when significantly elevated blood glucose and white blood cell count are found, will achieve good prognosis.