CAJ | 학술논문

目的总结手足口病重症病例的临床特征,以早期发现重症病例,阻止病情进展,提高救治水平.方法将我院收治的80例手足口病重症病例进行回顾性分析.根据病情分成4组,分别总结各组病例的临床症状、体征、辅助检查特点,通过统计学分析,发现有价值的重症病例早期临床特征性指标.结果 80例手足口病重症病例中,绝大部分患儿年龄小于5岁(94%),合并中枢神经系统病变70例(87.5%),无菌性脑膜炎21例(26.3%),弛缓性麻痹3例(3.8%),脑炎32例(40%),脑干脑炎9例(8.9%),脑脊髓炎4例(5%).神经源性肺水肿6例(7.5%).肠道病毒71型(EV71)感染51例(64%),柯萨奇病毒A16型感染7例(9%),中枢神经系统病变组EV71感染率明显增高,差异有显著性(X2=4.09,P＜0.05).79例(99%)出现发热,78例(97.5%)手、足、臀、膝出现不同程度皮疹;病情重者,皮疹反而越少.中枢神经系统病变组均不同程度出现精神差或烦躁不安,伴有四肢惊跳67例(95.7%).各组间高血糖的发生率差异有显著性(P＜0.05).中枢神经系统病变组脑脊液白细胞数均不同程度升高,各组之间差异无显著性(P＞0.05).床边脑电图监测提示不同程度背景活动变慢及慢波增加.头颅MRI异常8例.2例患儿死于神经源性肺水肿.结论我院收治手足口病重症病例中以中枢神经系统病变为主,FV71感染率较高,病情严重的患儿皮疹数目较少.精神差或烦躁不安、四肢惊跳是重症病例的早期临床特征,高血糖是有价值的病情判断指标.神经源性肺水肿是主要死亡原因.
목적 총결수족구병중증병례적림상특정,이조기발현중증병례,조지병정진전,제고구치수평.방법 장아원수치적80례수족구병중증병례진행회고성분석.근거병정분성4조,분별총결각조병례적림상증상、체정、보조검사특점,통과통계학분석,발현유개치적중증병례조기림상특정성지표.결과 80례수족구병중증병례중,절대부분환인년령소우5세(94%),합병중추신경계통병변70례(87.5%),무균성뇌막염21례(26.3%),이완성마비3례(3.8%),뇌염32례(40%),뇌간뇌염9례(8.9%),뇌척수염4례(5%).신경원성폐수종6례(7.5%).장도병독71형(EV71)감염51례(64%),가살기병독A16형감염7례(9%),중추신경계통병변조EV71감염솔명현증고,차이유현저성(X2=4.09,P＜0.05).79례(99%)출현발열,78례(97.5%)수、족、둔、슬출현불동정도피진;병정중자,피진반이월소.중추신경계통병변조균불동정도출현정신차혹번조불안,반유사지량도67례(95.7%).각조간고혈당적발생솔차이유현저성(P＜0.05).중추신경계통병변조뇌척액백세포수균불동정도승고,각조지간차이무현저성(P＞0.05).상변뇌전도감측제시불동정도배경활동변만급만파증가.두로MRI이상8례.2례환인사우신경원성폐수종.결론 아원수치수족구병중증병례중이중추신경계통병변위주,FV71감염솔교고,병정엄중적환인피진수목교소.정신차혹번조불안、사지량도시중증병례적조기림상특정,고혈당시유개치적병정판단지표.신경원성폐수종시주요사망원인.
Objective To summarize clinical features of severe cases of hand-foot-mouth disease and thereby to identify the severe cases in early stage and improve clinical outcome.Methods Eighty children with severe hand-foot-mouth disease were divided into four groups according their severity.The features of clinical manifestations were summarized and analyzed to determine the signs,symptoms and laboratory test which can identify severe cases in early stage.Results In the eighty hand-foot-mouth cases,seventy-five cases (94%)were within five years old.Seventy cases(87.5%)were complicated with central nervous system (CNS) involvement,showing twenty-one cases (26.3%) with aseptic meningitis,thirty-two cases (40%) with encephalitis,nine cases(8.9%)with brain stem encephalitis,four cases (5%) with myelitis,and six cases(7.5%)with neurogenic pulmonary edema.Fifty-one cases (64%)were infected by enterovirus 71(EV71),and seven cases (9%)were infected with coxsackieviruses A16(CxA16).CNS involvement was highly associated with EV71 infection.Seyenty-nine cases (99%)had fever.Seventy-eight cases (97.5%) had rashes over hands,feet,buttocks or knees.It was indicated that severe cascs usually had fewer rashes.The group with CNS involvement had somewhat malaise or irritability.Sixty-seven cases had myoclonic jerk(95.7%).Hyperglycemia incidence showed significant difference among different groups(P＜0.05).The cerebrospinal fluid (CSF) white cell counting increased in the group with CNS involvement but the difference between each group was not significant.Bedside continuous electroencephalograph (EEG) monitor indicated background activity was slow.Eight cases had abnormal head magnetic resonance imging (MRI) findings.Two cases died of neurogertic pulmonary edema.Conclusion The majority of severe handfoot-mouth disease cases are complicated with CNS involvement,and are highly associated with EV71 infection.The paitients under serious condition showed less skin rashes.Malaise,irritability and myoclonic jerk are the early clinical features of severe cases.Hyperglycemia is a worthy biomarker for early identification of severe case.Neurogenic pulmonary edema is the most common cause of mortality.