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目的探讨肠道病毒71型(EV71)脑干脑炎患儿的临床特征及治疗措施。方法选择菏泽市中医院2009年3-4月收治的EV71型感染手足口病(HFMD)并脑干脑炎病例(脑干脑炎组)及EV71型感染HFMD未并神经系统损伤病例(对照组),每组各20例。对二组患儿的临床资料(皮疹情况、神经系统受累症状和体征、辅助检查、治疗及转归等)进行回顾性分析。结果脑干脑炎组患儿年龄多在24个月以下,病情进展迅速。二组患儿均有皮疹和发热,不同部位皮疹量比较差异均无统计学意义(Pa>0.05)。脑干脑炎组最常见的临床表现为精神差、肌阵挛、抽动、易惊或烦躁、呕吐、震颤等。与对照组比较,脑干脑炎组患儿的发热热峰[(38.83±0.33)℃vs(38.43±0.55)℃]、心率[(154.25±25.81)次.m in-1vs(119.65±10.97)次.m in-1)]、收缩压[(15.56±1.89)kPavs(12.88±1.16)kPa]、舒张压[(10.14±1.53)kPavs(9.02±0.89)kPa]、血WBC计数[(9.10±3.49)×109L-1vs(7.24±1.42)×109L-1]、血糖[(7.23±3.92)mmol.L-1vs(4.90±1.82)mmol.L-1]均明显升高,其差异均有统计学意义(Pa<0.05)。所有患儿均按照分期治疗原则进行治疗,疗效较好。结论 EV71型脑干脑炎起病凶险,充分了解该病特点,早期识别出重症病例,并按照分期治疗原则进行治疗,对降低病死率有重要意义。
Objective To investigate the clinical features and treatment of children with enterovirus 71 (EV71) brainstem encephalitis. Methods Heze Hospital of Traditional Chinese Medicine from March to April 2009 were admitted to the HFMD and encephalitis (encephalitogenic group) and EV71-type HFMD not infected with nervous system injury (control group ), Each group of 20 cases. The clinical data of the two groups (rash, symptoms and signs of nervous system involvement, auxiliary examination, treatment and prognosis) were analyzed retrospectively. Results The brainstem encephalitis group was more than 24 months old and the disease progressed rapidly. There were rash and fever in both groups, and there was no significant difference in the amount of skin rash between different groups (Pa> 0.05). The most common clinical manifestations of brainstem encephalitis group is poor spirit, myoclonus, twitching, easy to panic or irritability, vomiting, tremor and so on. Compared with the control group, the fever peak (38.83 ± 0.33) ℃ vs (38.43 ± 0.55) ℃ and the heart rate [(154.25 ± 25.81)] m in-1vs (119.65 ± 10.97) Systolic pressure [(15.56 ± 1.89) kPavs (12.88 ± 1.16) kPa], diastolic pressure [(10.14 ± 1.53) kPavs (9.02 ± 0.89) kPa] and blood WBC count [(9.10 ± 3.49) × 109L-1vs (7.24 ± 1.42) × 109L-1] and blood glucose [(7.23 ± 3.92) mmol.L-1vs (4.90 ± 1.82) mmol.L-1] Significance (Pa <0.05). All children were treated according to the principle of staging, the effect is better. Conclusion The EV71-type brainstem encephalitis is dangerous and fully understand the characteristics of the disease. Early identification of severe cases and treatment according to the principle of staging treatment are of great significance in reducing mortality.