中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2014年
18期
1377-1380
,共4页
徐香芝%靳妍%张静%钱素云
徐香芝%靳妍%張靜%錢素雲
서향지%근연%장정%전소운
重症手足口病%肠道病毒71型%糖皮质激素%治疗
重癥手足口病%腸道病毒71型%糖皮質激素%治療
중증수족구병%장도병독71형%당피질격소%치료
Severe hand-foot-mouth disease%Enterovirus 71%Glucocorticoid%Treatment
目的 了解河南、四川两省糖皮质激素在重症手足口病中应用现状;比较不同剂量激素治疗重症手足口病的疗效.方法 采用回顾性多中心研究方法,按照等容量随机抽样法随机抽取河南、四川两省201 1年1月至5月320例重症手足口病例为研究对象,计算糖皮质激素静脉注射使用率.按激素使用情况将病例分为非激素治疗组、小剂量激素治疗组和大剂量激素治疗组,比较3组之间治愈率、发热持续时间、住院时间、神经系统症状持续时间、生命体征及血糖等.结果 320例患者中291例在住院治疗过程中静脉使用糖皮质激素,激素使用率为90.9％.3组之间治愈率差异无统计学意义(P＞0.05),且小剂量激素治疗组、大剂量激素治疗组患儿神经系统症状持续时间、住院时间、发热持续时间比非激素治疗组长,差异均有统计学意义(P均＜0.05);入院第3天,大剂量激素治疗组舒张压明显高于其他2组(P均＜0.05).结论 糖皮质激素在河南、四川两省广泛应用于重症手足口患儿的治疗,在发热、神经系统症状不缓解情况下更倾向于使用大剂量激素治疗.激素治疗重症手足口病患儿并未能提高治愈率,亦不能缩短病程、改善其临床症状,激素对于重症手足口病的疗效有待商榷,且大剂量激素治疗有可能增加患儿药物不良反应.
目的 瞭解河南、四川兩省糖皮質激素在重癥手足口病中應用現狀;比較不同劑量激素治療重癥手足口病的療效.方法 採用迴顧性多中心研究方法,按照等容量隨機抽樣法隨機抽取河南、四川兩省201 1年1月至5月320例重癥手足口病例為研究對象,計算糖皮質激素靜脈註射使用率.按激素使用情況將病例分為非激素治療組、小劑量激素治療組和大劑量激素治療組,比較3組之間治愈率、髮熱持續時間、住院時間、神經繫統癥狀持續時間、生命體徵及血糖等.結果 320例患者中291例在住院治療過程中靜脈使用糖皮質激素,激素使用率為90.9％.3組之間治愈率差異無統計學意義(P＞0.05),且小劑量激素治療組、大劑量激素治療組患兒神經繫統癥狀持續時間、住院時間、髮熱持續時間比非激素治療組長,差異均有統計學意義(P均＜0.05);入院第3天,大劑量激素治療組舒張壓明顯高于其他2組(P均＜0.05).結論 糖皮質激素在河南、四川兩省廣汎應用于重癥手足口患兒的治療,在髮熱、神經繫統癥狀不緩解情況下更傾嚮于使用大劑量激素治療.激素治療重癥手足口病患兒併未能提高治愈率,亦不能縮短病程、改善其臨床癥狀,激素對于重癥手足口病的療效有待商榷,且大劑量激素治療有可能增加患兒藥物不良反應.
목적 료해하남、사천량성당피질격소재중증수족구병중응용현상;비교불동제량격소치료중증수족구병적료효.방법 채용회고성다중심연구방법,안조등용량수궤추양법수궤추취하남、사천량성201 1년1월지5월320례중증수족구병례위연구대상,계산당피질격소정맥주사사용솔.안격소사용정황장병례분위비격소치료조、소제량격소치료조화대제량격소치료조,비교3조지간치유솔、발열지속시간、주원시간、신경계통증상지속시간、생명체정급혈당등.결과 320례환자중291례재주원치료과정중정맥사용당피질격소,격소사용솔위90.9％.3조지간치유솔차이무통계학의의(P＞0.05),차소제량격소치료조、대제량격소치료조환인신경계통증상지속시간、주원시간、발열지속시간비비격소치료조장,차이균유통계학의의(P균＜0.05);입원제3천,대제량격소치료조서장압명현고우기타2조(P균＜0.05).결론 당피질격소재하남、사천량성엄범응용우중증수족구환인적치료,재발열、신경계통증상불완해정황하경경향우사용대제량격소치료.격소치료중증수족구병환인병미능제고치유솔,역불능축단병정、개선기림상증상,격소대우중증수족구병적료효유대상각,차대제량격소치료유가능증가환인약물불량반응.
Objective To investigate the use of glucocorticoid in severe hand-foot-mouth disease in Henan and Sichuan Province and to compare the therapeutic effects of different dose of glucocorticoid.Methods In this multicenter retrospective study,320 cases of severe hand-foot-mouth disease,which were randomly sampled from Jan.to May 2011 in Henan and Sichuan Province were collected.The use of intravenous glucocorticoid was calculated.Accor-ding to the dose of corticosteroids which had been used,these cases were divided into 3 groups:the non-corticosteroids group,the low-dose group and the high-dose group.The cure rate,febrile duration,nervous system involvement duration,time of staying in hospital,vital signs and serum glucose in 3 groups were compared.Results Patients who used intravenous glucocorticoid accounted for 90.9％ (291/320 cases),and only 29 patients had not used (9.1％).The cure rate among 3 groups were not significantly different(P ＞0.05).In the low-dose group and the high-dose group,the nervous system involvement duration,the febrile duration and time of staying in hospital were longer than those in the non-corticosteroids group (all P ＜ 0.05).Comparing the blood pressure among 3 groups on the first day and the third day of hospitalization,the diastolic blood pressure in the high-dose group was much higher than that in other 2 groups on the third day of hospitalization(all P ＜ 0.05).Conclusions Glucocorticoid is generally used in severe hand-foot-mouth disease in Henan and Sichuan Province.The high-dose glucocorticoid is more often used in the situation that fever,nervous system involvement are not relieved.Glucocorticoid can never improve the cure rate in patients with severe hand-foot-mouth disease or shorten the course,relieve clinical symptoms.The therapeutic effects of glucocorticoid in severe hand-footmouth disease are not confirmed.The therapy of high-dose glucocorticoid may increase medicinal side effects.
