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目的识别儿童重症手足口病的早期表现,研究其治疗措施。方法对58例重症手足口病患儿的临床资料进行回顾性分析。结果 58例患儿,明确接触手足口病患儿35例,接触史不详者18例,既往曾患过手足口病者5例。全部病例均有发热,体温在37.5~40.2℃之间,明显皮疹或疱疹51例,隐约可见皮疹7例。白细胞(WBC)计数(4~10)×10~9/L 23例,(10~20)×10~9/L 25例,>20×10~9/L 10例。肠道病毒71型(EV71)抗体阳性44例,柯萨奇病毒A组16型(Cox A16)抗体阳性10例,两者均阴性4例。血糖>8.3 mmol/L 15例,3.9~8.3 mmol/L 43例。肝肾功能正常者40例,谷草转氨酶轻度升高13例,心电图正常35例,窦性心动过速或ST-T改变者10例,合并支气管肺炎者6例,脑电图异常者9例,脑脊液异常者6例,头颅CT异常者3例。识别筛出的58例早期重症手足口病患儿经严密监护,抗病毒、应用丙种球蛋白及糖皮质激素、对症支持等综合治疗,疗程7~10 d,全部痊愈出院,无死亡病例。结论早期重症手足口病在严密监护下,早期识别筛出,早期诊断,经积极治疗,是可控、可防、可治的。
Objective To identify the early manifestation of childhood severe hand-foot-mouth disease and to study its treatment. Methods The clinical data of 58 cases of severe hand-foot-mouth disease were retrospectively analyzed. Results 58 cases of children, clear exposure to hand-foot-mouth disease in 35 children, contact history unknown in 18 cases, previous had hand-foot-mouth disease in 5 cases. All cases have fever, body temperature between 37.5 ~ 40.2 ℃, 51 cases of obvious rash or herpes, rashes can be seen in 7 cases. There were 23 cases of WBC count (4 ~ 10) × 10 ~ 9 / L, 10 cases (10 ~ 20) × 10 ~ 9 / L and> 10 × 10 ~ 9 / L. 44 cases were positive for enterovirus 71 (EV71) antibody and 10 cases were positive for Cox A16 antibody, both of which were negative in 4 cases. Blood glucose> 8.3 mmol / L in 15 cases, 3.9 ~ 8.3 mmol / L in 43 cases. 40 cases of normal liver and kidney function, mild aspartate aminotransferase in 13 cases, 35 cases of normal electrocardiogram, sinus tachycardia or ST-T changes in 10 cases, bronchial pneumonia in 6 cases, 9 cases of abnormal EEG , 6 cases of abnormal cerebrospinal fluid, 3 cases of abnormal cranial CT. Fifty-eight cases of early-stage severe HFMD were screened, antivirus, immunoglobulin, glucocorticoid and symptomatic treatment were applied to treat 58 cases of early-stage HFMD. The course of treatment was 7 to 10 days and all were discharged without any deaths. Conclusion Early severe HFMD under strict surveillance, early identification of screening out, early diagnosis, after active treatment, is controllable, preventable, curable.