重癥手足口病臨床分析

[摘要] 目的 總結重癥手足口病的臨床特點，探討早期干預措施，阻止輕癥患兒向重癥患兒轉化。方法 采用回顧性分析，對128例HFMD患兒的相關臨床資料進行分析。 結果 128例患兒中，男81例，女47例，男女之比為1.72︰1，發病年齡最大5歲，其中0～3歲最多，占90.6%；大部分患兒熱程持續≥3 d，出現嗜睡、激惹、驚跳等神經系統表現；糞腸道病毒71型檢測陽性128例（100%）。 結論 重病癥及危重癥HFMD病例主要是EV71感染，年齡分布主要集中在1～5歲，尤其1～2歲。對于HFMD患兒應嚴密監測生命體征，早期發現危重病例，早期干預，以降低病死率，改善患兒預后。

[關鍵詞] 重癥手足口病；臨床特點

[中圖分類號] R512.5 [文獻標識碼] B [文章編號] 2095-0616（2012）22-231-02

Clinical analysis of severe hand-foot-mouth disease

WANG Hongqing NIU Mingyang

Department of Internal Pediatrics， Children's Hospital of Xuzhou City， Xuzhou 221006， China

[Abstract] Objective To summarize the clinical features of hand-foot-mouth disease， explore early intervention measures， and prevent patients transforming from mild symptoms to severe symptoms. Methods The clinical data of 128 children with HFMD were analyzed retrospectively. Results Of the 128 children， 81 were male and 47 were female， with the male to female ratio of 1.72︰1 and the maximum onset age of 5 years old. Children aging 0 to 3 years old were the majority， accounting for 90.6%. Most children's fever duration sustained for≥3 days， showing drowsiness， irritation， startle and other neurological manifestations. Fecal and intestinal tract virus type 71test found 128 positive patients （100%）. Conclusion Patients with severe symptoms and acute severe symptoms were mainly infected with EV71， mostly aging from 1 to 5 years old， especially from 1 to 2 years old. For children with HFMD， vital signs should be monitored closely， acute severe patients should be detected early and early intervention should be implemented in order to reduce the case fatality rate and improve patients' prognosis.

[Key words] Severe hand-foot-mouth disease； Clinical features

手足口病（hand，foot and mouth disease，HFMD）是由腸道病毒引起的急性傳染病，多發生于學齡前兒童。腸道病毒71型（EV71）是病原之一[1]。大多數病情輕微，以發熱和手、足、口部皮疹為臨床特征，極少數重癥患兒并發神經系統疾病，如病毒性腦膜炎、病毒性腦炎、急性弛緩性麻痹、腦干腦炎等，個別重癥病例病情進展快，出現神經源性肺水腫、肺出血、呼吸循環衰竭，易致死亡[2]。重癥患兒的早期診斷、積極盡早干預是提高療效、降低死亡率的關鍵。本研究對2010年1月～至2011年6月筆者所在醫院感染科收治的128例重癥HFMD患兒的臨床特征進行回顧性分析。

1 資料與方法

1.1 一般資料

28例重癥HFMD患兒均符合衛生部制定的《腸道病毒（EV71）感染診療指南（2010年版）》診斷標準，其中男81例，女47例，男女之比為1.72︰1；年齡為8個月～5歲，平均（2.3±1.5）歲，年齡<1歲7例（5.5%），～2歲68例（53.12%），～3歲41例（32.03%），～5歲12例（9.37%）。全部病例均進行糞病原學檢測，由徐州市疾病預防控制中心測定。……