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[目的]探讨肠道病毒7l型(Enterovims71,EV71)所致重症手足口病(hand foot and mouth disease,HFMD)患儿的临床特征及其预防控制措施。[方法]对34例手足口病患儿严格消毒隔离,密切观察病情变化,做好皮肤黏膜、用药及机械通气护理,密切监护,注意严重并发症的发生。[结果]男孩手足口病的发病率略高于女孩。人对人肠道病毒普遍易感。手足口病在各年龄组人群中均可发生,以5岁及5岁以下儿童为主,尤以3岁及3岁以下儿童发病率最高。本组68例患儿均有发热,热峰最高达39.8℃;手足及肛周见少许散在疱疹24例;嗜睡、意识模糊,肌力下降、反应差36例;惊跳、四肢抖动、抽搐28例;气促、心动过速54例;心动过缓8例;高血压30例;低血压16例;尿储留46例;肺水肿、肺出血22例。实验室检查结果显示危重症患儿的WBC、血糖、血乳酸明显高于重症患儿(P﹤0.05);CK-MB在危重症与重症之间差异无统计学意义(P﹥0.05)。按照卫生部制定的《手足口病诊疗指南》(2010年版)进行治疗,本组68例患儿中治愈好转58例,自动出院6例,死亡2例。1例在入院24h之内死亡,1例在院外自服药物治疗,入院时已出现MODS,神经原性肺水肿,抢救72h无效死亡。[结论]早发现、早报告、早诊断、早治疗是控制EV71所致手足口病扩散最有效措施。
[Objective] To investigate the clinical features and prevention and control of severe foot and mouth disease (HFMD) in Enteroviruses 71 (EV71). [Method] Thirty - four HFMD children were strictly disinfected and isolated. The changes of the disease were observed closely. Skin and mucous membranes, medication and mechanical ventilation were taken care of closely and the serious complications were noted. [Results] The incidence of hand, foot and mouth disease in boys was slightly higher than that in girls. People are generally susceptible to human enteroviruses. Hand, foot and mouth disease can occur in all age groups, with children aged 5 and under, most often children aged 3 and under. 68 cases of children with fever, peak up to 39.8 ℃; hand and foot and perianal see a little scattered herpes in 24 cases; lethargy, confusion, decreased muscle strength, poor response in 36 cases; jumped, limbs jitter, convulsions 28 Cases; shortness of breath, tachycardia in 54 cases; bradycardia in 8 cases; hypertension in 30 cases; hypotension in 16 cases; 46 cases of urinary retention; pulmonary edema, pulmonary hemorrhage in 22 cases. Laboratory tests showed that WBC, blood glucose and blood lactate in critically ill children were significantly higher than those in critically ill children (P <0.05). There was no significant difference in CK-MB between critically ill patients and severe ones (P> 0.05). According to the Handbook of Diagnosis and Treatment of Hand-Foot-Mouth Disease (2010 Edition) developed by the Ministry of Health, 58 patients were cured, 6 were discharged automatically and 2 died. One patient died within 24h of admission, one patient was treated with drugs outside the hospital, MODS and neurogenic pulmonary edema appeared on admission, and 72 hours of rescue died. [Conclusion] Early detection, early report, early diagnosis and early treatment are the most effective measures to control the spread of hand-foot-mouth disease caused by EV71.