CAJ | 학술논문

目的了解肠道病毒71型首发肺水肿或肺出血的暴发性致死性的临床特征.方法回顾分析3例的临床表现,化验检查,诊断,治疗转归等.结果此3例均死亡,病初仅有发热、呕吐等非特异性症状,均无手足口臀部皮疹,发病后1～2 d病情迅速恶化,突发口唇发绀,呼吸急促.3例均误诊,因考虑感染性休克而扩容.均未能早期认识肺出血,直至出现口鼻吐血性液、全身发绀等才行气管插管,气管内均见大量血性泡沫液.3例血糖显著升高和肌张力降低,2例心动过速,1例高血压.3例胸片双侧或单侧渗出性病变,心影不大,3例外周血白细胞均升高,3例咽拭子、气管分泌液和1例脑脊液样本均检测到肠道病毒71型.结论婴幼儿首发肺水肿或肺出血患儿,符合肠道病毒71型感染特点,发生神经源性肺水肿或肺出血,急诊医生对该类疾病认识和处理不足.婴幼儿病初仅发热伴呕吐,数天后突发口唇发绀,呼吸急促,心动过速,高血压或低血压,肌张力低下,应高度怀疑该病,警惕肺水肿、肺出血.及时告知预后不良,扩容将迅速加剧病情恶化,应严格控制液体,早期气管插管正压通气,积极心功能支持.
목적 료해장도병독71형수발폐수종혹폐출혈적폭발성치사성적림상특정.방법 회고분석3례적림상표현,화험검사,진단,치료전귀등.결과 차3례균사망,병초부유발열、구토등비특이성증상,균무수족구둔부피진,발병후1～2 d병정신속악화,돌발구진발감,호흡급촉.3례균오진,인고필감염성휴극이확용.균미능조기인식폐출혈,직지출현구비토혈성액、전신발감등재행기관삽관,기관내균견대량혈성포말액.3례혈당현저승고화기장력강저,2례심동과속,1례고혈압.3례흉편쌍측혹단측삼출성병변,심영불대,3예외주혈백세포균승고,3례인식자、기관분비액화1례뇌척액양본균검측도장도병독71형.결론 영유인수발폐수종혹폐출혈환인,부합장도병독71형감염특점,발생신경원성폐수종혹폐출혈,급진의생대해류질병인식화처리불족.영유인병초부발열반구토,수천후돌발구진발감,호흡급촉,심동과속,고혈압혹저혈압,기장력저하,응고도부의해병,경척폐수종、폐출혈.급시고지예후불량,확용장신속가극병정악화,응엄격공제액체,조기기관삽관정압통기,적겁심공능지지.
Objective To recognize the clinical features of the enterovims 71(Ev71)infection with pulmonary edema or pulmonary hemorrhage as a fulminant and often fatal illness.Methods We retrospectively reviewed the medical records of the three cases with EV71 infection for chnical manifestation.laboratory data.medications.outcome etc.Results All the cases were infants and they all died.These infants had no skin or mucosal lesions.however.they had sudden onset of cyanesis and tachypnea 1 to 2 days after the onset of the febrile disease with vomiting.All these 3 cases were misdiagnosed and were treated for shock on admission.Pulmonary hemorrhage wag not considered in any ofthe cssea on admission.All the cases received tracheal intubation when foamy secretions were discharged from mouth and noge of the patients and notable cyanoais Wag noted.After intubation.all had pink foamy fluid flew out from the endotracheal tube.The patients had hyperglycemia and limb weakness,two had tachycardia,and hypertension Was found in one cage.Chest X-ray showed bilateral or unilateral widespread air space opacity.but the cardiac size and shape were normal.All the patients had leucocytosis.EV71 infection Was confirmed by detection of specific sequences of the virns in throat swab and tracheal secretions samples and in one case in cerebrospinal fluid sample.Condusion Pulmonary edema or pulmonary hemorrhage occurred in the 3 cases with EV71-infected infants.The initial presentation was often nonspecific with fever and vomiting.and sudden appearances of cyanosis,tachypnea,tacllycardia,hypertension or hypotension,limb weakness may suggest pulmonary edema or hemorrhage.Excessive fluid resuscitation may deteriorate the illness,on the contrary,fluid restriction and inotropic agents,and early intubation with positive pressure mechanical ventilation may be the proper treatment.