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目的探讨重症手足口病(HFMD)的临床特征及治疗情况,为其防治提供依据。方法回顾性分析焦作市妇幼保健院2009年3月—2011年5月收治的164例重症HFMD患儿的临床资料。结果 164例中农村患儿明显多于城镇,男性患儿多于女性,以6～36个月发病人数最多,多在病程第三至五天进展为重症;多以发热为首发症状,均有皮疹;半数以上患儿有易惊、肢体抖动或无力及精神差和/或嗜睡等重症表现,并发症主要为心肌损害、肺炎及中枢神经系统感染;实验室检查可见血白细胞、空腹血糖升高,心肌酶谱异常,X线胸片可见双肺炎症病变;早期应用甘露醇、免疫球蛋白、短期大剂量激素治疗效果好,治愈150例,好转13例,放弃治疗1例。结论 3岁以内HFMD患儿在病程的第三至五天易发展成重症,出现持续高热、肢体抖动及肌阵挛、恶心、呕吐、嗜睡多提示病情危重;外周血白细胞计数增多、血糖升高,心肌酶谱、X线胸片异常动态变化较快为重症高危因素;早期应用甘露醇、免疫球蛋白、短期大剂量激素有望提高重症HFMD抢救成功率、降低病死率。
Objective To investigate the clinical features and treatment of severe hand-foot-mouth disease (HFMD) and provide basis for its prevention and treatment. Methods A retrospective analysis of 164 cases of severe HFMD in Jiaozuo MCH hospital from March 2009 to May 2011 was performed. Results Among 164 cases, there were more children in rural areas than in urban areas. There were more males than females, with the highest incidence in 6 ~ 36 months and the most serious progress in the third to fifth days of the disease course. Most of them had fever as the first symptom, Rash; more than half of children with easy to panic, limb jitter or weakness and poor mental performance and / or drowsiness and other severe symptoms, the main complications of myocardial damage, pneumonia and central nervous system infections; laboratory tests showed leukocytes, elevated fasting blood glucose , Abnormal myocardial enzymes, chest X-ray visible lung inflammation lesions; early application of mannitol, immunoglobulin, short-term high-dose hormone treatment effect, cure 150 cases, improved in 13 cases, give up treatment in 1 case. Conclusions HFMD patients within 3 years of age may develop severe symptoms during the third to fifth days of the course of disease. Persistent high fever, limb jitter and myoclonus, nausea, vomiting, and drowsiness are all indications for critically ill patients. Peripheral blood leukocyte counts and hyperglycemia , Myocardial zymogram, X-ray abnormal dynamic changes in the fast as a serious risk factors; early application of mannitol, immunoglobulin, short-term high-dose hormone is expected to improve the success rate of severe HFMD rescue and reduce mortality.