CAJ | 학술논문

目的探讨早期发现手足口病重症病例.并进行积极干预对预后的意义.方法回顾性分析220例手足口病住院患儿中9例重症患儿的起病、进展,血液及脑脊液,心、脑电图监测指标,治疗措施及预后.统计学处理采用Pearson x2检验和t检验.结果 9例重症患儿均有神经系统受累表现.但临床表现有所不同:脑膜刺激征和(或)病理征阳性9例.伴嗜睡7例,肢体抖动乏力6例,排尿障碍3例,感觉过敏3例,自主神经功能失调2例,共济失调1例,左下肢轻瘫1例,早期肺水肿1例.在尚未出现心肺功能衰竭前进行积极救治,给予丙种球蛋白、甲泼尼龙琥珀酸钠、甘露醇以及限制液体摄人量等.结果无一例患儿病死,1例脑脊髓炎患儿左下肢跛行,至6周恢复,1例脑干脑炎患儿随访至8周.脑电图仍持续异常但无临床症状.结论肠道病毒71引起的重症于足口病可并发脑炎、脑膜炎、肺水肿等,在尚未发展至种经源性肺水肿时积极治疗,可降低病死率,改善预后.
목적 탐토조기발현수족구병중증병례.병진행적겁간예대예후적의의.방법 회고성분석220례수족구병주원환인중9례중증환인적기병、진전,혈액급뇌척액,심、뇌전도감측지표,치료조시급예후.통계학처리채용Pearson x2검험화t검험.결과 9례중증환인균유신경계통수루표현.단림상표현유소불동:뇌막자격정화(혹)병리정양성9례.반기수7례,지체두동핍력6례,배뇨장애3례,감각과민3례,자주신경공능실조2례,공제실조1례,좌하지경탄1례,조기폐수종1례.재상미출현심폐공능쇠갈전진행적겁구치,급여병충구단백、갑발니룡호박산납、감로순이급한제액체섭인량등.결과 무일례환인병사,1례뇌척수염환인좌하지파행,지6주회복,1례뇌간뇌염환인수방지8주.뇌전도잉지속이상단무림상증상.결론 장도병독71인기적중증우족구병가병발뇌염、뇌막염、폐수종등,재상미발전지충경원성폐수종시적겁치료,가강저병사솔,개선예후.
Objective To investigate the significance of early diagnosis and intervention in cases with severe hand-foot-mouth disease. Methods Nine severe cases were chosen from 220 hospitalized children with hand-foot-mouth disease for retrospective analysis, including onset, disease progression, the blood and cerebrospinal fluid tests, electroencephalogram data, patients' treatment responses and prognosis. Pearson X2 test and t test were utilized for statistical analysis. Results All cases showed nervous systems involved symptom, including meningeal irritation sign and (or) other pathological signs of nervous system (9 cases), drowsy (7 cases), trembling (6 cases), voiding dysfunction (3 cases), hypersensitivity(3 cases), autonomic nervous system disorders (2 cases), ataxia (1 case), left leg mild paralysis (1 case) and early stage of pulmonary edema (1 case). Early intervention, such as high dose gamma globulin, methylprednisolone, mannitol treatment restriction of fluid input, started before the development of heart and lung failure. No case died but one patient with encephalomyelitis showed hobbling left leg, which didn't recover until 6 weeks later. One case with brainstem encephalitis still showed abnormal electroencephalogram after 8 weeks follow-up but without clinical symptom. Conclusions Enterovirus 71 can cause severe hand-foot-mouth disease complicated by encephalitis, meningitis and pulmonary edema. Early active intervention before the development of neurogenic pulmonary edema can improve the prognosis and reduce the mortality.