CAJ | 학술논문

目的总结重症手足口病(HFMD)并发脑炎患儿的临床特征及病原学分析.方法对我院2011年6月收治住院的279患儿中的214例重症HFMD并发脑炎患儿积极给予甘露醇脱水降颅压、短期应用激素,抗感染、对症支持治疗.31例危重型患儿给予吸氧、米力农、酚妥拉明治疗.危重型病例及病情较重的重症病例49例加用丙种球蛋白治疗.6例呼吸、循环衰竭患儿应用机械通气.粪便RT-PCR核酸检测213例.结果 279例中重症患儿214例,占76.70％；男女比例1.55∶1；城乡比1∶1.24;212例患儿发热,入院时平均热程2.91 d,热度在39～40℃ 169例(79.72％).所有患儿均出现HFMD典型皮疹.患儿主要表现为膝腱反射亢进199例(92.99％)、颈抵抗191例(89.25％)和易惊166例(77.57％)等.所以患儿均有脑脊液异常.212例患儿治愈出院；2例下肢瘫痪患儿病情明显好转出院,随访2周后治愈.本组病例平均住院时间7.43d(5～18 d).213例粪便送检检出病原200例(93.90％),其中191例为EV71,占检出病原的95.50％.结论本院收治的患儿重症的比例较高,对于危重型患儿,积极给予酚妥拉明、米力农治疗,积极降低颅内压力及抗感染治疗可最大限度降低病死率和致残率.EV71仍是HFMD的主要致病病原.
목적 총결중증수족구병(HFMD)병발뇌염환인적림상특정급병원학분석.방법 대아원2011년6월수치주원적279환인중적214례중증HFMD병발뇌염환인적겁급여감로순탈수강로압、단기응용격소,항감염、대증지지치료.31례위중형환인급여흡양、미력농、분타랍명치료.위중형병례급병정교중적중증병례49례가용병충구단백치료.6례호흡、순배쇠갈환인응용궤계통기.분편RT-PCR핵산검측213례.결과 279례중중증환인214례,점76.70％；남녀비례1.55∶1；성향비1∶1.24;212례환인발열,입원시평균열정2.91 d,열도재39～40℃ 169례(79.72％).소유환인균출현HFMD전형피진.환인주요표현위슬건반사항진199례(92.99％)、경저항191례(89.25％)화역량166례(77.57％)등.소이환인균유뇌척액이상.212례환인치유출원；2례하지탄탄환인병정명현호전출원,수방2주후치유.본조병례평균주원시간7.43d(5～18 d).213례분편송검검출병원200례(93.90％),기중191례위EV71,점검출병원적95.50％.결론본원수치적환인중증적비례교고,대우위중형환인,적겁급여분타랍명、미력농치료,적겁강저로내압력급항감염치료가최대한도강저병사솔화치잔솔.EV71잉시HFMD적주요치병병원.
Objective To summarize clinical feature of severe hand,foot and mouth disease (HFMD) complicating encephalitis and analyze its pathogens.Methods A total of 214 severe HFMD cases complicating encephalitis hospitalized children in June 2011 in our hospital were entrolled in 279 HFMD cases.214 cases were given milrinone to decrease intracranial pressure.Hormone and antivirus drug were applied in a short-term to resistance the infection,and other adjuvant therapy.31 critical cases were given the oxygen,milrinone and phentolamine during the treatment.49 cases who were critical cases or more severe cases were give intravenous immunoglobulin,6 cases combined with respiratory and circulatory failure and applied the mechanical ventilation.Excrement etiology of 213 cases were detected by RT-PCR.Results In 279 patients,of 214 cases were severe HFMD,account for 76.70％.The proportion of male and female was 1.55∶1.The ratio of urban and rural area was 1 ∶ 1.24.There were 212 cases had fever and the mean course of fever before going to hospital was 2.91 days.The temperature of 169 cases were 39-40 ℃ (79.72％).All the patients had HFMD typical rashes.The main menifestations were knee jerk reflex hyperfunction( 199 cases,92.99％),neck resistance ( 191 cases,89.25％ ),and easy to panic(166 cases,77.57％ ),cerebrospinal fluid of all patients were abnormal.212 patients were cured,2 cases with acute flaccid paralysis of lower extremity had significantly better on discharge and continued to use prednisone and a variety of vitamins,and were cured when following up for 2 weeks.The average hospitalization time was 7.43 days(5-18 days).200 cases were detected enteric virus in213 cases (93.90％),in which EV71 were 191 cases (95.50％).Conclusions A higher proportion of severe HFMD patients are admitted in our hospital.To the critical cases,phenollamin and milrinone should be given as soon as possible.Actively reducing the intracranial pressure and anti-infection treatment could decrease the mortality and morbidity in maximum.EV71 was still the main pathogen