CAJ | 학술논문

目的探讨重症手足口病的病原学并总结其临床诊治经验.方法对昆明市儿童医院2010年1月至12月收治住院的1304例手足口病患儿中的782例(59.97％)重症病例(均并发脑炎)的临床特征、治疗、转归及病原学分析进行回顾性分析.结果 782例患儿中734例患儿粪便行半巢式RT-PCR核酸检测并测序:检出病原565例(76.98％),阴性124例,无同源45例；其中柯萨奇病毒A组16型(CoxA16)306例(54.16％),肠道病毒71(EV71)型220例(38.94％).经积极有效治疗,除3例神经源性肺水肿抢救无效死亡外,775例临床症状消失,治愈出院,3例并发瘫痪及1例频繁抽搐患儿好转出院.结论 2010年重症手足口病痛原以CoxA16为主,EV71次之.临床上对于持续高热、头痛(年长儿)、呕吐、四肢抖动、颈抵抗、膝反射亢进等患儿要高度重视,并发中枢神经系统感染者病情进展快,早期发现,早期诊断、早期抢救治疗,防止神经源性肺水肿、脑干脑炎的发生,是最大限度降低手足口病病死率、致残率的关键.
목적 탐토중증수족구병적병원학병총결기림상진치경험.방법 대곤명시인동의원2010년1월지12월수치주원적1304례수족구병환인중적782례(59.97％)중증병례(균병발뇌염)적림상특정、치료、전귀급병원학분석진행회고성분석.결과 782례환인중734례환인분편행반소식RT-PCR핵산검측병측서:검출병원565례(76.98％),음성124례,무동원45례；기중가살기병독A조16형(CoxA16)306례(54.16％),장도병독71(EV71)형220례(38.94％).경적겁유효치료,제3례신경원성폐수종창구무효사망외,775례림상증상소실,치유출원,3례병발탄탄급1례빈번추휵환인호전출원.결론 2010년중증수족구병통원이CoxA16위주,EV71차지.림상상대우지속고열、두통(년장인)、구토、사지두동、경저항、슬반사항진등환인요고도중시,병발중추신경계통감염자병정진전쾌,조기발현,조기진단、조기창구치료,방지신경원성폐수종、뇌간뇌염적발생,시최대한도강저수족구병병사솔、치잔솔적관건.
[Objective] To investigate the pathogens and summarize the clinical experiences of severe hand-foot and mouth disease(HFMD).[Methods] Seven hundred and eighty-two cases (59.97％)of sever HFMD(complicating with encephalitis)among the 1304 cases of HFMD admitted in our hospital from January 2010 to December 2010 were entrolled in this study.The clinical features,prognosis,treatment and pathogens of children with severe HFMD were retrospectively analyzed.[Results] Amplification by semi-nested RT-PCR(snRT-PCR)and sequence analysis were done,the genomic RNA was extracted from stool specimens from 754 cases,565 cases(74.93％)were positive,124 cases were negative,45 cases were not homologym.Amongst the positive samples,the predominant isolated was CoxA16(54.16％),the second was EV71(38.94％).By positive treatment,775 among the 782 cases were cured and left hospital,3 cases of acute flaccid paralysis and 1 case of frequent convulsions had improve and discharged from hospital,but 3 cases died of neurogenic pulmonary edema.[Conclusions] HFMD is a common intestinal infectious diseases in pediatrics,the main pathogen of severe HFMD were CoxA16,and the second was EV71.Clinical doctors should pay more attention to the cases of continuous fever,headache,vomiting,extremities tremble,neck resistance,and to observe condition closely for the children complicated with central nervous system infection during clinical therapy.Early diagnosis,early treatment and prevention of pulmonary edema and brainstem encephalitis is the key to minimize the fatality rate and disability rate of severe HFMD.