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目的分析重症手足口病致神经源性肺水肿患儿的临床表现,总结其诊断依据,探讨其有效的治疗方法。方法采用回顾性分析的方法对阜阳市第二人民医院收治的23例重症手足口病致神经源性肺水肿病例的相关信息进行分析,包括临床表现、血常规、血生化检查、病原学检测、脑脊液和X线胸片检查。4月20日前收治的6例患儿予常规抗炎、强心等综合治疗;4月20后,17例患儿予降颅压,大剂量甲泼尼龙及丙种球蛋白冲击治疗或机械通气治疗。结果本组病例多发生于3岁以下儿童,多有发热,神经系统、呼吸系统、循环系统发生病理生理改变,多数病例出现血白细胞、血清CK、血清CK-MB、血糖、CRP、血小板计数升高。脑脊液检查提示无菌性炎性反应。胸片提示进展迅速的肺实变影。行病原学检测7例患儿中,5例EV71病毒呈阳性,占71.42%。尸检显示肺组织淤血、水肿、出血,支气管黏膜可见中性粒细胞浸润;中枢神经系统则表现为脑炎、脑膜炎和脊髓炎。4月20前6例未行机械通气治疗患儿均于入院10 h左右死亡;4月20日后治疗17例患儿中,9例临床治愈,4例自动出院,4例死亡。结论重症手足口病致神经源性肺水肿起病急、发展迅速、病死率较高。机械通气、脱水降颅压、大剂量激素和静脉用丙种球蛋白冲击治疗可改善预后,抢救的关键在于早期发现和正确处理。
Objective To analyze the clinical manifestations of children with neurogenic pulmonary edema caused by severe hand-foot-mouth disease, and to summarize its diagnostic basis and explore its effective treatment. Methods The retrospective analysis was used to analyze the related information of 23 cases of neurogenic pulmonary edema caused by severe hand-foot-mouth disease in Second People’s Hospital of Fuyang City, including clinical manifestations, blood tests, blood biochemical tests, pathogenic tests, Cerebrospinal fluid and X-ray examination. April 20 before the treatment of 6 children to conventional anti-inflammatory, cardiac and other comprehensive treatment; April 20 after 17 cases of intracranial pressure, high-dose methylprednisolone and gamma globulin shock therapy or mechanical ventilation . Results Most of the cases occurred in children under 3 years of age with fever, nervous system, respiratory system and circulatory system pathophysiological changes. In most cases, blood leukocyte, serum CK, serum CK-MB, blood glucose, CRP, platelet count high. Cerebrospinal fluid examination suggests aseptic inflammatory reaction. Chest radiography prompt rapid progress of lung consolidation shadow. Among the 7 cases tested by pathogen, 5 cases of EV71 were positive, accounting for 71.42%. Autopsy showed lung tissue congestion, edema, hemorrhage, bronchial mucosa visible neutrophil infiltration; central nervous system is manifested as encephalitis, meningitis and myelitis. April 20 before 6 cases of mechanical ventilation in children were admitted to hospital about 10 h died; April 20 after the treatment of 17 cases of children, 9 cases were clinically cured, 4 cases were discharged automatically and 4 died. Conclusion Severe hand, foot and mouth disease caused by acute exacerbation of neurogenic pulmonary edema, rapid development, high mortality. Mechanical ventilation, dehydration reduced intracranial pressure, high-dose hormones and intravenous gamma globulin impact therapy can improve the prognosis, the key to rescue lies in the early detection and correct treatment.