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目的探讨开封市轻症和重症手足口病临床表现、就诊过程及重症发生可能因素。方法按手足口病发病率高低将所辖县分为高中低三层,每层随机抽取一县,每县完全随机抽取病例50例,开展病案、入户和电话调查。结果 14.19%病例接触手足口病病人后发病,潜伏期3 d;与轻症比较,重症发病年龄小,发热较早,体温高、发热持续时间长;出疹较晚,多部位皮疹;其他症状和体征多在发病后第3 d出现,多见精神差、食欲不振、呕吐,心率改变、脑膜刺激征;常并发病毒性脑炎和心肌炎;重症病例首诊确诊率低,转诊多,所需确诊时间长;基层医院手足口病确诊率低。结论重症起病不典型,发病后3 d是疾病病程改变的关键期,加强此期对病人的密切观察,及时发现病情的改变、提高基层医院对手足口病的诊断能力,是提高疾病正确分型和及时治疗,控制传染源,减少病死率的关键。
Objective To investigate the clinical manifestations, treatment process and possible causes of severe hand-foot-mouth disease in Kaifeng City. Methods According to the incidence of hand-foot-mouth disease, the county was divided into high, middle and low three layers, each county randomly selected a county, each county completely randomly selected 50 cases, to carry out medical records, home and telephone survey. Results 14.19% of cases were exposed to hand-foot-mouth disease and had an incubation period of 3 days. Compared with mild cases, the age of severe onset was younger, the fever started earlier, the body temperature was higher, and the duration of fever was longer. Signs and more in the first 3 d after onset, more common mental retardation, loss of appetite, vomiting, heart rate changes, meningeal irritation; often complicated by viral encephalitis and myocarditis; first diagnosis of critically ill patients with low diagnosis, referral and more Diagnosis of a long time; grass-roots hospital hand-foot-mouth disease diagnosis rate is low. Conclusions Severe onset is not typical, 3 d after the onset of disease is the key period of disease change, strengthen the close observation of patients during this period, and timely detection of disease changes, improve the diagnosis of hand-foot-mouth disease in grassroots hospitals is to improve the correct disease Type and timely treatment, control of sources of infection, reduce the critical fatality.