58例兒童重癥手足口病的早期識別與治療措施臨床研究

蔡卓宏　楊俏蘭　溫土冊

【摘要】 目的 識別兒童重癥手足口病的早期表現(xiàn)， 研究其治療措施。方法 對58例重癥手足口病患兒的臨床資料進行回顧性分析。結(jié)果 58例患兒， 明確接觸手足口病患兒35例， 接觸史不詳者18例， 既往曾患過手足口病者5例。全部病例均有發(fā)熱， 體溫在37.5～40.2℃之間， 明顯皮疹或皰疹51例， 隱約可見皮疹7例。白細胞（WBC）計數(shù)（4～10）×109/L 23例， （10～20）×109/L 25例， ﹥20×109/L 10例。腸道病毒71型（EV71）抗體陽性44例， 柯薩奇病毒A組16型（CoxA16）抗體陽性10例， 兩者均陰性4例。血糖﹥8.3 mmol/L 15例， 3.9～8.3 mmol/L 43例。肝腎功能正常者40例， 谷草轉(zhuǎn)氨酶輕度升高13例， 心電圖正常35例， 竇性心動過速或ST-T改變者10例， 合并支氣管肺炎者6例， 腦電圖異常者9例， 腦脊液異常者6例， 頭顱CT異常者3例。識別篩出的58例早期重癥手足口病患兒經(jīng)嚴密監(jiān)護， 抗病毒、應用丙種球蛋白及糖皮質(zhì)激素、對癥支持等綜合治療， 療程7～10 d， 全部痊愈出院， 無死亡病例。結(jié)論 早期重癥手足口病在嚴密監(jiān)護下， 早期識別篩出， 早期診斷， 經(jīng)積極治療， 是可控、可防、可治的。

【關(guān)鍵詞】 重癥手足口病；兒童；早期識別；治療措施

DOI：10.14163/j.cnki.11-5547/r.2017.25.015

【Abstract】 Objective To identify the early manifestation of severe hand-foot-mouth disease， and study its treatment measures. Methods Clinical data of 58 severe hand-foot-mouth disease children were retrospectively analyzed. Results Among 58 children， there were 35 hand-foot-mouth disease cases with clear contact， 18 cases with unknown contact history and 5 cases with hand-foot-mouth disease history. All cases had fever， the body temperature was between 37.5～40.2℃. There were 51 cases with obvious rash or herpes， and

7 cases with vaguely visible rash. There were 23 cases with white blood cell （WBC） count as （4～10）×109/L，

25 cases as （10～20）×109/L， and 10 cases as >20×109/L. Enterovirus 71 （EV71） antibodies were positive in

44 cases， and coxsackievirus A 16 （CoxA16） antibodies were positive in 10 cases， both were negative in 4 cases. There were 15 cases with blood glucose> 8.3 mmol/L and 43 cases in 3.9 ～ 8.3 mmol/L. There were 40 normal liver and kidney function cases， 13 aspartate aminotransferase slightly increased cases， 35 normal electrocardiogram cases， 10 sinus tachycardia or ST-T change cases， 6 bronchial pneumonia cases， 9 abnormal electrocardiogram cases， 6 abnormal cerebrospinal fluid cases， and 3 abnormal brain CT cases. After comprehensive therapy of intensive care， antiviral， globulin and glucocorticoid， symptomatic and supportive treatment for 7～10 d， 58 cases of early screening of children with severe hand-foot-mouth disease all cured and discharged， no death cases. Conclusion Early severe hand-foot-mouth disease， under strict supervision， early identification and screening， early diagnosis and active treatment， is controllable， preventable and treatable.

【Key words】 Severe hand-foot-mouth disease； Children； Early identification； Treatment measures

手足口病（HFMD）是多種人腸道病毒引起的兒童常見傳染病， 以嬰幼兒為主。大多數(shù)患兒癥狀輕微， 以發(fā)熱及手、足、口腔黏膜、肛周皮膚等部位皮疹或皰疹為主要特征。少數(shù)患兒由于病毒侵犯中樞神經(jīng)系統(tǒng)、呼吸系統(tǒng)引起腦膜炎、心肌炎、急性馳緩性麻痹、神經(jīng)源性肺水腫， 尤其以腦干腦炎進展惡化快， 常常導致死亡。目前引起重癥手足口病的常見病毒包括EV71和CoxA16。本文通過回顧性分析， 探討重癥手足口病早期表現(xiàn)， 從而及早識別， 早期診斷， 在嚴密觀察監(jiān)護下， 采取積極的治療措施， 取得顯著的治療效果。現(xiàn)報……