传染病信息
傳染病信息
전염병신식
INFECTIOUS DISEASE INFORMATION
2014年
2期
105-108
,共4页
杨德华%易冬玲%谭钧元%周晓飞%蓝英%张朝勇%张亦维%龙露萍%李继科
楊德華%易鼕玲%譚鈞元%週曉飛%藍英%張朝勇%張亦維%龍露萍%李繼科
양덕화%역동령%담균원%주효비%람영%장조용%장역유%룡로평%리계과
手足口病%危重病%治疗结果%体征和症状
手足口病%危重病%治療結果%體徵和癥狀
수족구병%위중병%치료결과%체정화증상
hand,foot and mouth disease%critical illness%treatment outcome%signs and symptoms
目的：探讨重型手足口病的临床特点，以总结救治经验。方法回顾性分析我院2011年1月-2012年12月收治的484例手足口病的临床表现和治疗情况。结果本组患儿男女比为1.5∶1，年龄（2.17±0.60）岁，病程（2.74±1.19）d，住院天数（6.14±1.78）d。临床症状和体征主要有手和（或）足部皮疹（100%）、精神差（98.1%）、发热（95.7%）、惊跳（95.7%）、激惹（94.4%）、心率加快（81.8%）、呕吐（40.1%）、血压升高（36.6%）和肢体抖动（33.9%）。实验室检查异常指标主要有白细胞计数升高（60.1%）、心肌损伤（38.0%）、血糖升高（32.9%）、血乳酸升高（31.0%）。脑脊液检查为病毒性脑炎改变，脑部CT/MRI检查均未见异常。病原学检查以EV71感染为主（65.1%）。经抗病毒和对症治疗，应用静脉免疫球蛋白（intravenous immunoglobulin, IVIG）、米力农（甲氰吡酮）、甘露醇和地塞米松等治疗后，所有患儿均痊愈出院，无一例转为危重型。结论重型手足口病早期临床表现较隐匿，精神差、惊跳、激惹为神经系统最主要表现。早期诊断并及时应用甘露醇和地塞米松，血压升高时及时应用米力农，血糖和白细胞明显升高时酌情应用IVIG，则预后良好。
目的：探討重型手足口病的臨床特點，以總結救治經驗。方法迴顧性分析我院2011年1月-2012年12月收治的484例手足口病的臨床錶現和治療情況。結果本組患兒男女比為1.5∶1，年齡（2.17±0.60）歲，病程（2.74±1.19）d，住院天數（6.14±1.78）d。臨床癥狀和體徵主要有手和（或）足部皮疹（100%）、精神差（98.1%）、髮熱（95.7%）、驚跳（95.7%）、激惹（94.4%）、心率加快（81.8%）、嘔吐（40.1%）、血壓升高（36.6%）和肢體抖動（33.9%）。實驗室檢查異常指標主要有白細胞計數升高（60.1%）、心肌損傷（38.0%）、血糖升高（32.9%）、血乳痠升高（31.0%）。腦脊液檢查為病毒性腦炎改變，腦部CT/MRI檢查均未見異常。病原學檢查以EV71感染為主（65.1%）。經抗病毒和對癥治療，應用靜脈免疫毬蛋白（intravenous immunoglobulin, IVIG）、米力農（甲氰吡酮）、甘露醇和地塞米鬆等治療後，所有患兒均痊愈齣院，無一例轉為危重型。結論重型手足口病早期臨床錶現較隱匿，精神差、驚跳、激惹為神經繫統最主要錶現。早期診斷併及時應用甘露醇和地塞米鬆，血壓升高時及時應用米力農，血糖和白細胞明顯升高時酌情應用IVIG，則預後良好。
목적：탐토중형수족구병적림상특점，이총결구치경험。방법회고성분석아원2011년1월-2012년12월수치적484례수족구병적림상표현화치료정황。결과본조환인남녀비위1.5∶1，년령（2.17±0.60）세，병정（2.74±1.19）d，주원천수（6.14±1.78）d。림상증상화체정주요유수화（혹）족부피진（100%）、정신차（98.1%）、발열（95.7%）、량도（95.7%）、격야（94.4%）、심솔가쾌（81.8%）、구토（40.1%）、혈압승고（36.6%）화지체두동（33.9%）。실험실검사이상지표주요유백세포계수승고（60.1%）、심기손상（38.0%）、혈당승고（32.9%）、혈유산승고（31.0%）。뇌척액검사위병독성뇌염개변，뇌부CT/MRI검사균미견이상。병원학검사이EV71감염위주（65.1%）。경항병독화대증치료，응용정맥면역구단백（intravenous immunoglobulin, IVIG）、미력농（갑청필동）、감로순화지새미송등치료후，소유환인균전유출원，무일례전위위중형。결론중형수족구병조기림상표현교은닉，정신차、량도、격야위신경계통최주요표현。조기진단병급시응용감로순화지새미송，혈압승고시급시응용미력농，혈당화백세포명현승고시작정응용IVIG，칙예후량호。
Objective To investigate the clinical features of children with severe hand, foot and mouth disease (HFMD), and summarize the experience in diagnosis and treatment of severe HFMD. Methods The clinical manifestations and treatment of 484 children with severe HFMD treated in our hospital from Jan. 2011 to Dec. 2012 were analyzed retrospectively. Results The ratio of male and female children was 1.5∶1, the average age was 2.17±0.60 years old, the average disease course was 2.74±1.19 days, and the average duration of hospitalization was 6.14±1.78 days. The main clinical signs and symptoms were rash on hand and/or foot (100%), fatigue (98.1%), fever (95.7%), startling (95.7%), irritation (94.4%), increased heart rate (81.8%), vomiting (40.1%), hypertension (36.6%) and limb shaking (33.9%). Laboratory abnormalities were abnormally elevated white blood cell count (60.1%), myocardial injury (38.0%), elevated blood glucose (32.9%) and elevated blood lactate (31.0%). Cerebrospinal fluid examination showed viral en-cephalitis, but brain CT and MRI showed that no brain abnormality was found. Enterovirus 71 (65.1%) was the most common pathogen. After antiviral therapy and symptomatic treatment, such as intravenous injection of intravenous immunoglobulin (IVIG), milrinone, man-nitol and dexamethasone, all the patients were cured and discharged, and no patient progressed to critical illness. Conclusions The early clinical features of severe HFMD are hard to detect. The typical neurological features include fatigue, startling and irritation. Early di-agnosis and treatment with mannitol and dexamethasone timely, with milrinone timely when hypertension is found and with IVIG proper-ly when significantly elevated blood glucose and white blood cell count are found, will achieve good prognosis.
