CAJ | 학술논문

目的提高对重症手足口病的早期诊治率，降低临床死亡率。方法2010年7月1日~2011年7月10日在我院住院并确诊为手足口病（HFMD）的94例患儿为研究组，同期住院并确诊为非手足口病病毒性脑炎的20例患儿作为对照组，常规做血常规、血糖、心肌酶检查，摄胸片，部分行心电图、头颅MRI及脑电图检查，对44例出现惊跳、肢体抖动或无力、精神萎靡、嗜睡的手足口病患儿和20例非手足口病病毒性脑炎的患儿进行早期脑脊液检查。结果手足口病轻症和重症患儿在发热、惊跳、肢体抖动、嗜睡、心率、血糖、WBC计数、L、N分类等体征和检验结果等方面有显著性差异(<0.05)。手足口病重症与非手足口病病毒性脑炎在脑脊液细胞计数方面统计上有显著性差异（<0.05）。一旦出现上述体征和检验结果，早期诊断重症手足口病，在常规治疗基础上，及时给与甘露醇、糖皮质激素、丙种球蛋白和对症治疗，疗效良好，治愈好转率100%，所有病例没有进展成手足口病危重症，无后遗症及死亡病例。结论手足口病（HFMD）轻症患儿，当出现高热不退，心率加快，出现惊跳、肢体抖动、嗜睡等体征时，是临床发生重症手足口病的重要警示信号。及时行脑脊液检查，脑脊液检查提示细胞计数增多，多以单个核细胞为主，WBC和N偏高等利于早期诊断，及时给予治疗效果良好。
목적제고대중증수족구병적조기진치솔，강저림상사망솔。방법2010년7월1일~2011년7월10일재아원주원병학진위수족구병（HFMD）적94례환인위연구조，동기주원병학진위비수족구병병독성뇌염적20례환인작위대조조，상규주혈상규、혈당、심기매검사，섭흉편，부분행심전도、두로MRI급뇌전도검사，대44례출현량도、지체두동혹무력、정신위미、기수적수족구병환인화20례비수족구병병독성뇌염적환인진행조기뇌척액검사。결과수족구병경증화중증환인재발열、량도、지체두동、기수、심솔、혈당、WBC계수、L、N분류등체정화검험결과등방면유현저성차이(<0.05)。수족구병중증여비수족구병병독성뇌염재뇌척액세포계수방면통계상유현저성차이（<0.05）。일단출현상술체정화검험결과，조기진단중증수족구병，재상규치료기출상，급시급여감로순、당피질격소、병충구단백화대증치료，료효량호，치유호전솔100%，소유병례몰유진전성수족구병위중증，무후유증급사망병례。결론수족구병（HFMD）경증환인，당출현고열불퇴，심솔가쾌，출현량도、지체두동、기수등체정시，시림상발생중증수족구병적중요경시신호。급시행뇌척액검사，뇌척액검사제시세포계수증다，다이단개핵세포위주，WBC화N편고등리우조기진단，급시급여치료효과량호。
Objective To increase early diagnosis rate and reduce the clinical mortality rate of severe hand, foot and mouth disease (HFMD).Methods Between 2010/7/1 to 2011/7/10 , 94 cases children diagnosed as HFMD as study group, 20 cases children diagnosed as viral encephalitis as control group. Al cases examined blood routine, blood glucose and the myocardial enzymes, taken chest X-rays, part of the cases did ECG, cranial MRI and EEG. 44 cases HFMD children appearedjumping, imbs shaking or weakness, mental fatigue, hypnosia and 20 cases viral encephalitis children check early CSF. Results Light and severe HFMD children between fever, jumping, body shaking, hypnosia,heart rate, WBC, L, N classification signs and inspection results weresignificant dif erence ( <0.05). Severe HFMD and viral encephalitis children' cel counting in CSF were significant dif erence ( < 0.05). Once appeared above signs and inspection results, was early given diagnosis of severe HFMD. Except antiviral treatment, given timely mannitol, glucocorticoid, gamma globulin and symptomatic treatment, ef ect was good because cure and improvement rate were 100%, no cases progressed into critical HFMD, without sequelae and deaths.Conclusion When occur ence high fever was not retreated, heart rate increased, jumping, body shaking, sleepiness signs and cel counting and mononuclear cel s in CSF increased , high blood sugar, peripheral blood count WBC and N increased etc., which was the important warning signal of the mild HFMD progress severe HFMD.Benefit for early diagnosis. Ef ect of timely treatment was good.