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目的探讨危重型手足口病的临床特点。方法回顾分析31例危重型手足口病的临床特点、治疗及转归。结果危重型手足口病临床表现多出现高热、精神差、食欲不振;神经系统症状多出现肢体抖动、呕吐、意识障碍;呼吸系统多以呼吸增快、肺部罗音;口唇发绀、心律增快症状。实验室检查多有血白细胞、血糖、CK-MB、肌钙蛋白、脑脊液白细胞和脑脊液糖的升高,胸片多有明显的肺部感染征象,头颅MRI检查则多表现为脑干损伤。EV71引发所占比例明显高于CA16。治疗上予以大剂量激素和免疫球蛋白冲击治疗,配合积极的脱水降颅压,所有患儿均使用呼吸机辅助通气治疗。10例痊愈,9例好转,8例因病情持续无改善自动出院,死亡4例。结论早期识别危重型手足口病临床特征,及时、积极干预治疗,是减少后遗症、降低死亡率的关键。
Objective To explore the clinical features of critically ill hand-foot-mouth disease. Methods Retrospective analysis of 31 cases of critically ill hand-foot-mouth disease clinical features, treatment and prognosis. Results The clinical manifestations of critically ill hand-foot-mouth disease were mostly fever, poor spirits and loss of appetite. Jaundice, vomiting and disturbance of consciousness occurred in neurological symptoms. Respiratory system increased respiratory rate, lung rales, cyanosis of lips, symptom. Laboratory tests of blood white blood cells, blood glucose, CK-MB, troponin, cerebrospinal fluid leukocytes and cerebrospinal fluid sugar increased, chest X-ray obvious signs of pulmonary infection, head MRI is more manifested as brain stem injury. The proportion of EV71 priming was significantly higher than that of CA16. Treatment of large doses of hormones and immunoglobulin impact treatment, with a positive dehydration reduced intracranial pressure, all children were treated with ventilator-assisted ventilation. 10 cases recovered, 9 cases improved, 8 cases due to continuous improvement of the disease was not discharged, 4 patients died. Conclusion Early identification of the clinical features of critically ill hand-foot-mouth disease, timely and active intervention is the key to reduce sequelae and reduce mortality.