CAJ | 학술논문

目的：总结危重型手足口病（ HFMD）临床诊治经验及病原学分析。方法选择636例危重型手足口病患儿，均给予并发脑炎的常规治疗。本研究患儿均出现高血压，624例给予静脉滴注酚妥拉明8~20μg/（ kg·min），其中143例高血压仍未控制，改用静脉滴注硝普钠，血压稳定后逐渐减量至停药。46例呼吸、循环衰竭患儿（其中20例神经源性肺水肿、肺出血）在入院12 h内应用机械辅助通气。结果未给予降压治疗的12例危重型HFMD患儿机械通气治疗11例，5例（41.67%）死于肺出血；2例病情好转出院，后失访。624例危重型HFMD患儿及时给予治疗、控制高血压，机械通气治疗35例，7例死于肺出血，2例好转出院后失访。631例做粪便病原检测：其中EV71阳性495例。结论目前 HFMD 己成为儿科较常见、危害儿童健康的重要肠道传染病，危重型HFMD病原以EV71为主。本研究患儿均出现高血压，高血压严重程度与肺水肿成正比。本研究624例在治疗脑炎的同时积极治疗控制高血压，明显减少了机械通气的应用及静脉丙种球蛋白的应用，降低了医疗成本，取得了满意疗效。重视及尽早发现、及时治疗控制高血压是抢救危重型HFMD患儿最重要措施之一，是最大限度降低危重型 HFMD患儿病死率、致残率的关键。
목적：총결위중형수족구병（ HFMD）림상진치경험급병원학분석。방법선택636례위중형수족구병환인，균급여병발뇌염적상규치료。본연구환인균출현고혈압，624례급여정맥적주분타랍명8~20μg/（ kg·min），기중143례고혈압잉미공제，개용정맥적주초보납，혈압은정후축점감량지정약。46례호흡、순배쇠갈환인（기중20례신경원성폐수종、폐출혈）재입원12 h내응용궤계보조통기。결과미급여강압치료적12례위중형HFMD환인궤계통기치료11례，5례（41.67%）사우폐출혈；2례병정호전출원，후실방。624례위중형HFMD환인급시급여치료、공제고혈압，궤계통기치료35례，7례사우폐출혈，2례호전출원후실방。631례주분편병원검측：기중EV71양성495례。결론목전 HFMD 기성위인과교상견、위해인동건강적중요장도전염병，위중형HFMD병원이EV71위주。본연구환인균출현고혈압，고혈압엄중정도여폐수종성정비。본연구624례재치료뇌염적동시적겁치료공제고혈압，명현감소료궤계통기적응용급정맥병충구단백적응용，강저료의료성본，취득료만의료효。중시급진조발현、급시치료공제고혈압시창구위중형HFMD환인최중요조시지일，시최대한도강저위중형 HFMD환인병사솔、치잔솔적관건。
Objective To summarize the experience of diagnosis and treatment of critical hand foot and mouth disease( HFMD)and pathogen analysis. Methods The 636 cases of critical hand foot and mouth disease were chosen,and all cases were given conventional treatment for encephalitis. All of the patients had hypertension,624 patients were treated with intravenous injection of phentolamine 8 -20 μg/( kg·min),including 143 cases of uncontrolled hypertension,and were given intravenous sodium nitroprusside,the dosages gradually reduced to withdrawal after the blood pressure was steady. Forty-six cases of respiratory and circulatory failure( including 20 cases of neurogenic pulmonary edema,pulmonary hemorrhage)were given mechanical ventilation within 12 hours of admission. Results Among the 12 cases without antihypertensive treatment, 11 cases were given mechanical ventilation, 5 cases( 41 . 67%) died of pulmonary hemor-rhage,2 cases improved and lost follow-up. The 624 cases of critical HFMD were given antihypertensive therapy and control of hypertension,35 cases were given mechanical ventilation,7 cases died of pulmo-nary hemorrhage,2 cases improved and lost follow-up. 631 cases had fecal pathogens detection:495 ca-ses with positive EV71. Conclusions HFMD is an important infectious disease in pediatrics,it made serious harm to the health of children. EV71 infection is the main reason which caused critical cases. All cases had hypertension,and the severity of hypertension is proportional to the severity of HFMD. The 624 cases were given the treatment of encephalitis at the same time of active treatment of hypertension,signifi-cantly reduced the application of intravenous immunoglobulin and mechanical ventilation,reduced the cost of medical care,obtained satisfactory curative effect. Attention and early detection,timely treatment and control of hypertension is the most important measures for rescue critical HFMD and minimize the mortality and morbidity of critical HFMD.