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目的探明重症手足口病例发生原因,为今后预防和控制重症手足口病提供科学依据。方法对2010—2012年报告的2例重症手足口病患儿按2010年和2012版《手足口病顸防控制指南》进行流行病学调查和分析处理。结果 2例死亡病例中男女各1例,男儿为2岁7个月;女孩为11个月,经病原学确诊均为EV71感染重症手足口病死亡病例,临床表现有发热及手足口部位出现疱疹/丘疹/口腔溃疡或疱疹症状,都并发有神经系统、循环系统、呼吸系统症状;病情进展迅速,从发病到死亡不足4 d,两例死亡病例均有在村卫生所就诊的经历。而村卫生所没有贯彻落实“村级随访、乡镇留观、县级救治、市级重症”的医疗救治策略,私自截留收治病儿,耽误了抢救的宝贵时间。结论重症手足口病死亡病例常好发于3岁以下农村儿童,夏季为发病高峰时段,及早发现重症病例,及早转省儿童医院救治,及早上呼吸机进行机械通气抢救病例,是防止重症手足口病患儿死亡的唯一重要措施。同时采取隔离传染源,切断传播途径,加强密切接触者医学观察,发现续发病例及时到指定收治医院就诊等是处理重症手足口病和防止疫情扩散的主要措施。
Objective To investigate the causes of severe hand-foot-mouth disease and provide a scientific basis for the prevention and control of severe hand-foot-mouth disease in the future. Methods Two cases of severe HFMD reported in 2010-2012 were investigated and analyzed according to the 2010 and 2012 Guidelines for Prevention and Control of HFMD. Results Two cases of death were found in one male and one female, the male was 2 years and 7 months, and the female was 11 months. The deaths from severe hand-foot-mouth disease (EV71) were confirmed by etiological diagnosis. The clinical manifestations were fever and herpes / Papules / mouth ulcers or herpes symptoms, are complicated by nervous system, circulatory system, respiratory symptoms; condition progressed rapidly, from onset to death less than 4 d, two cases of deaths in the village clinics experience. However, the village clinics did not implement the medical treatment strategy of “village-level follow-up, township observation, county-level treatment and municipal-level severe disease”, and privately confiscating the sick children and saving the precious time of rescue. Conclusions Severe cases of hand, foot and mouth disease deaths often occur in rural children under 3 years of age, the summer peak incidence period, early detection of severe cases, early Provincial Children’s Hospital for treatment, and early ventilator for mechanical ventilation rescue cases, is to prevent severe hand, foot and mouth The only important measure for the death of sick children. At the same time, the main measures to deal with severe hand-foot-mouth disease and prevent the spread of the epidemic should be to isolate the source of infection, cut off the route of transmission, strengthen the medical observation of close contacts and find out the recurrence cases to the designated hospital for treatment in time.