中国医药导报
中國醫藥導報
중국의약도보
China Medical Herald
2015年
29期
59-62
,共4页
危重症%手足口病%儿童%临床特征%脑干听觉诱发电位
危重癥%手足口病%兒童%臨床特徵%腦榦聽覺誘髮電位
위중증%수족구병%인동%림상특정%뇌간은각유발전위
Critical illness%Hand-foot-mouth disease%Children%Clinical feature%Brainstem auditory evoked potential
目的：总结分析危重症手足口病(HFMD)患儿的临床表现特点，研究早期干预治疗措施。方法选择2011年8月~2014年1月广州市妇女儿童医疗中心儿童医院院区收治的118例危重症HFMD患儿作为研究对象，回顾性分析所有患儿的临床表现特征，对其进行血生化、血常规、心电图、胸片、头颅MRI或CT、EEG、脑干听觉诱发电位检查(BAEP)等辅助检查，以及积极的早期干预治疗措施，必要时给予机械通气；随访1年，观察并记录其转归情况。结果危重症HFMD临床特征：大部分患儿年龄小于3岁，发热严重；神经系统病症方面，主要表现有：精神差、肢体震颤、烦躁和惊跳，伴随高血糖和高血压等现象；BAEP和头颅MRI检查表现异常；110例患儿需给予呼吸机机械通气治疗。转归率为89.0%(105/118)，随访1年后，好转患儿均未发现显著的智力衰退、肢体瘫痪或者继发性癫痫；13例患儿死亡，其中2例为家属放弃治疗。结论严密观察HFMD患儿的病情变化过程，通过对患儿的临床表现特点归纳分析及施行相关的辅助检查，及早识别该疾病的高危因素并采取积极的早期干预治疗措施，对缩减危重症HFMD患儿严重后遗症、最大限度降低致残率和死亡率，以及改善其预后起着关键作用。
目的：總結分析危重癥手足口病(HFMD)患兒的臨床錶現特點，研究早期榦預治療措施。方法選擇2011年8月~2014年1月廣州市婦女兒童醫療中心兒童醫院院區收治的118例危重癥HFMD患兒作為研究對象，迴顧性分析所有患兒的臨床錶現特徵，對其進行血生化、血常規、心電圖、胸片、頭顱MRI或CT、EEG、腦榦聽覺誘髮電位檢查(BAEP)等輔助檢查，以及積極的早期榦預治療措施，必要時給予機械通氣；隨訪1年，觀察併記錄其轉歸情況。結果危重癥HFMD臨床特徵：大部分患兒年齡小于3歲，髮熱嚴重；神經繫統病癥方麵，主要錶現有：精神差、肢體震顫、煩躁和驚跳，伴隨高血糖和高血壓等現象；BAEP和頭顱MRI檢查錶現異常；110例患兒需給予呼吸機機械通氣治療。轉歸率為89.0%(105/118)，隨訪1年後，好轉患兒均未髮現顯著的智力衰退、肢體癱瘓或者繼髮性癲癇；13例患兒死亡，其中2例為傢屬放棄治療。結論嚴密觀察HFMD患兒的病情變化過程，通過對患兒的臨床錶現特點歸納分析及施行相關的輔助檢查，及早識彆該疾病的高危因素併採取積極的早期榦預治療措施，對縮減危重癥HFMD患兒嚴重後遺癥、最大限度降低緻殘率和死亡率，以及改善其預後起著關鍵作用。
목적：총결분석위중증수족구병(HFMD)환인적림상표현특점，연구조기간예치료조시。방법선택2011년8월~2014년1월엄주시부녀인동의료중심인동의원원구수치적118례위중증HFMD환인작위연구대상，회고성분석소유환인적림상표현특정，대기진행혈생화、혈상규、심전도、흉편、두로MRI혹CT、EEG、뇌간은각유발전위검사(BAEP)등보조검사，이급적겁적조기간예치료조시，필요시급여궤계통기；수방1년，관찰병기록기전귀정황。결과위중증HFMD림상특정：대부분환인년령소우3세，발열엄중；신경계통병증방면，주요표현유：정신차、지체진전、번조화량도，반수고혈당화고혈압등현상；BAEP화두로MRI검사표현이상；110례환인수급여호흡궤궤계통기치료。전귀솔위89.0%(105/118)，수방1년후，호전환인균미발현현저적지력쇠퇴、지체탄탄혹자계발성전간；13례환인사망，기중2례위가속방기치료。결론엄밀관찰HFMD환인적병정변화과정，통과대환인적림상표현특점귀납분석급시행상관적보조검사，급조식별해질병적고위인소병채취적겁적조기간예치료조시，대축감위중증HFMD환인엄중후유증、최대한도강저치잔솔화사망솔，이급개선기예후기착관건작용。
Objective To explore clinical features and treatment protocols of children with critical hand foot and mouth disease (HFMD). Methods 118 patients with HFMD who were treated in Children's Hospital District of Guangzhou Women and Children's Medical Center from August 2011 to January 2014 were chosen as research objects. Their symp-tomatic features were analyzed retrospectively. A lot of auxiliary examinations including blood routine, blood biochem-istry, chest film, electrocardiogram, cranial MRI or CT, EEG, BAEP were carried among the research objects. They were treated with positive early intervention measures and given mechanical ventilation when necessary. The long out-comes were observed and recorded for 1 year. Results The clinical features of critical HFMD:most of the patients aged under three and had high fever; they had neurological manifestations like limbs tremor, short of vigour, dysphoria and pavor and often accompanied with increased blood glucose and blood pressure, pulmonary edema and pulmonary hem-orrhage; BAEP and cranial MRI showed abnormal; 110 patients received mechanical ventilation. 105 cases were cured or discharged from hospital with improvement with obsolete mental retardation, secondary epilepsy and limb paralysis after 1 year follow-up. Of 13 death cases, 2 cases of patients died from withdrawing breathing machine because their family members gave up treatment. Conclusion The changes of condition in children with HFMD should be closely monitored. Analyzing of the symptomatic characteristics of patients and related auxiliary examination is helpful for i-dentify the high risk factors of children with critical HFMD and take positive early intervention measures. All these have critical effect on reducing severe sequela of children with critical HFMD, decreasing disability rate and death rate to the upmost and improving the prognosis.
