CAJ | 학술논문

【目的】探讨手足口病（H FM D ）危重症早期机械通气的时机选择，以合理把握时机，降低危重症HFMD的病死率及致残率和避免过度医疗。【方法】选择本院感染科ICU收治2012年5月至2014年12月符合我国卫生部《手足口病诊疗指南2010年版》标准，并按照《肠道病毒71型（EV71）感染重症病例临床救治专家共识（2011年版）》条例应用机械通气治疗的123例患儿的临床资料进行回顾性分析；123例中男75例，女48例；发病年龄3个月至4．4岁，平均（1．89±1．04）岁；将病例按照机械通气时气道分泌物的状况分为两组。A组：插管时已有口鼻分泌物溢出，B组插管时仅咽部有分泌物溢出。对两组病例的症状、体征、血糖、氧合指数、住院天数、机械通气时间、预后的资料进行比较分析。【结果】A、B组病例氧合指数（283．59±67，155．19±40．70）相差128．4；机械通气时间（9．50±4．10，6．21±2．44）d、相差3．2d；住院时间（16．21±4．4，13．28±2．09）d ，相差2．9 d；治愈好转率（66．53％，89．13％）相差23．4％，B组氧合指数、机械通气时间、平均住院日、治愈好转率等指标均明显优于 A 组，且两组相比较差异有显著性（ P ＜0．01）。【结论】危重症H FM D患儿在中枢神经受损早期当咽部有分泌物时及应进行机械通气，从而可以明显降低患儿病死率和治疗成本。
【목적】탐토수족구병（H FM D ）위중증조기궤계통기적시궤선택，이합리파악시궤，강저위중증HFMD적병사솔급치잔솔화피면과도의료。【방법】선택본원감염과ICU수치2012년5월지2014년12월부합아국위생부《수족구병진료지남2010년판》표준，병안조《장도병독71형（EV71）감염중증병례림상구치전가공식（2011년판）》조례응용궤계통기치료적123례환인적림상자료진행회고성분석；123례중남75례，녀48례；발병년령3개월지4．4세，평균（1．89±1．04）세；장병례안조궤계통기시기도분비물적상황분위량조。A조：삽관시이유구비분비물일출，B조삽관시부인부유분비물일출。대량조병례적증상、체정、혈당、양합지수、주원천수、궤계통기시간、예후적자료진행비교분석。【결과】A、B조병례양합지수（283．59±67，155．19±40．70）상차128．4；궤계통기시간（9．50±4．10，6．21±2．44）d、상차3．2d；주원시간（16．21±4．4，13．28±2．09）d ，상차2．9 d；치유호전솔（66．53％，89．13％）상차23．4％，B조양합지수、궤계통기시간、평균주원일、치유호전솔등지표균명현우우 A 조，차량조상비교차이유현저성（ P ＜0．01）。【결론】위중증H FM D환인재중추신경수손조기당인부유분비물시급응진행궤계통기，종이가이명현강저환인병사솔화치료성본。
[Objective] To explore the clinical characteristics of children with critical hand‐foot‐mouth dis‐ease (HFMD) on mechanical ventilation so as to reduce the mortality and disability rates and avoid excessive medical care .[Methods] A total of 123 children with critical HFMD were admitted into intensive care unit be‐tween May 2012 and December 2014 according to the Diagnosis & Treatment Guidelines of Hand ,Foot and Mouth Disease ,2010 .And mechanical ventilation was initiated according to the Expert Consensus on Clinical Control of Severe Enterovirus 71 (EV71) Infection ,2011)〗 .Their clinical data were retrospectively analyzed . There were 75 boys and 48 girls with a mean age of 1 .89 ± 1 .04 (0 .25~4) years .Base upon the presence of airway secretions during mechanical ventilation ,they were divided into group A (nose and mouth secretion during intubation) and group B (pharyngeal secretion during intubation) .Their symptoms ,signs ,blood glu‐cose ,oxygenation index ,hospitalization duration ,mechanical ventilation time and prognosis of two groups are compared by statistical software .[Results] The discrepancy in oxygenation index (283 .59 ± 67 ,155 .19 ± 40 .70) was 128 .4 ,time of mechanical ventilation (9 .50 ± 4 .10 ,6 .21 ± 2 .44) 3 .2 days ,length of hospital stay (16 .21 ± 4 .4 ,13 .28 ± 2 .09) 2 .9 days and curative rate (66 .53% ,89 .13% ) 23 .4% .The oxygenation index ,mechanical ventilation time ,hospitalization duration and curative rate were significantly better in group B than those in group A .And there were significant inter‐group differences ( P <0 .01) .[Conclusion] Chil‐dren of critical HFMD with central nerve injury should receive early mechanical ventilation in case of pharynge‐al secretion .And it may significantly reduce mortality and treatment costs .