CAJ | 학술논문

目的探讨肠道病毒71型( enterovirus,EV71)感染重症病例的临床表现分期、监护及治疗措施.方法 2010年5月至2011年9月我院重症医学科共收治EV71感染重症病例45例.持续监测生命体征,危重患儿监测动脉血压、中心静脉压、混合静脉血氧饱和度、动态无创心功能和尿量等.根据临床表现,将患儿分为3个阶段:(1)神经系统受累阶段；(2)呼吸系统受累阶段；(3)循环系统受累阶段(代偿期及失代偿期).根据不同阶段,采用个体化救治措施及监护.结果 45例患儿中,38例治愈出院,治愈率为84.4％；死亡7例,全部为循环功能衰竭患儿.38例患儿中19例局限于神经系统受累；12例病情止步于呼吸系统受累阶段,7例为循环系统受累阶段.结论早期识别EV71感染重症病例,积极控制高热、合适的液体治疗、控制高血压、早期呼吸支持,防止患儿发生循环功能衰竭是救治关键.进行分阶段、个体化综合救治可能有效治疗重症EV71感染.
목적 탐토장도병독71형( enterovirus,EV71)감염중증병례적림상표현분기、감호급치료조시.방법 2010년5월지2011년9월아원중증의학과공수치EV71감염중증병례45례.지속감측생명체정,위중환인감측동맥혈압、중심정맥압、혼합정맥혈양포화도、동태무창심공능화뇨량등.근거림상표현,장환인분위3개계단:(1)신경계통수루계단；(2)호흡계통수루계단；(3)순배계통수루계단(대상기급실대상기).근거불동계단,채용개체화구치조시급감호.결과 45례환인중,38례치유출원,치유솔위84.4％；사망7례,전부위순배공능쇠갈환인.38례환인중19례국한우신경계통수루；12례병정지보우호흡계통수루계단,7례위순배계통수루계단.결론 조기식별EV71감염중증병례,적겁공제고열、합괄적액체치료、공제고혈압、조기호흡지지,방지환인발생순배공능쇠갈시구치관건.진행분계단、개체화종합구치가능유효치료중증EV71감염.
Objective To investigate the clinicalmanifestation,monitoring and therapeutic measure of severe enterovirus 71 ( EV71 ) infection in children.Methods Forty-five cases of severe EV71 infection were admitted in our PICU from May 2010 to Sep 2011.The vital sign and arterial blood pressure,central venous pressure,mixed venous oxygen saturation,dynamic non-invasive heart function and urine volume were monitored.Forty-five cases were divided into 3 stages according to clinical manifestation:( 1 ) nervous system involvement stage; (2) respiratory system involvement stage; ( 3 ) circulatory system involvement stage ( compensation and decompensation).We adopted individualized remedy measure according to different stages.Results In 45 cases,38 cases discharged from hospital,the cure rate was 84.4％.Among all the 38 cases,nervous system involvement was found in 19 cases,respiratory system involvement was found in 12 cases,circulatory system involvement was found in 7 cases.Seven cases died,who had circulation failure.Conclusion We should identify severe EV71 infection early.Positive control of high fever,appropriate liquid treatment,control of high blood pressure,early respiratory support,preventment of circulation failure are the key measures for treatment.Individualized monitoring and treatment are effective in children with severe EV71 infection.