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目的:探讨儿童手足口病的临床特征。方法:归纳分析包括97例重症病例的502例手足口病患儿的发病年龄及病例来源、症状和体征、实验室与辅助检查、并发症、治疗及转归等临床资料。结果与结论:3岁以下患儿占80.3%。男性发生率(69.9%)明显高于女性(30.1%)。外地移居或暂居儿童发生率(59.8%)略高于本地儿童(40.2%)。患儿均有皮疹,皮疹可同时出现在手、足、口部(43.6%)及臀部(45.8%)。452例(90.0%)患儿发热,热型不规则,多在皮疹出现前1～2d开始发热。伴肢体抖动16.1%、膝反射亢进9.0%,均多见于重症病例。部分病例可见白细胞明显增多(11.0%),CRP升高(23.8%)。27例重症患儿行病原学检查,肠道病毒71型阳性占70%,柯萨奇病毒A16型阳性占15%。重症患儿并发支气管炎(93%)、肺炎(83%)及心肌炎(43%)等。经对症及抗病毒治疗,治愈484例(96.4%),死亡2例(均为EV71阳性的重症患儿)。手足口病多见于幼儿,此次流行以普通病例为主,主要症状为发热及皮疹,重症患儿多有肢体抖动、膝反射亢进。只要及早诊断,予正确的治疗,手足口病预后良好。
Objective: To investigate the clinical features of hand, foot and mouth disease in children. Methods: The clinical data of 502 cases of hand, foot and mouth disease in 97 severe cases were analyzed including the age of onset and the source, symptoms and signs of the cases, laboratory and auxiliary examination, complications, treatment and prognosis. Results and conclusion: 80.3% of children under 3 years of age. The incidence of males (69.9%) was significantly higher than that of females (30.1%). The incidence of migrants or children living in foreign countries (59.8%) was slightly higher than that of local children (40.2%). Children have rashes, rash can occur in the hands, feet, mouth (43.6%) and buttocks (45.8%). 452 cases (90.0%) had fever and irregular heat pattern, and fever started 1 ~ 2 days before rash appeared. With jitter 16.1%, knee hyperreflexia 9.0%, are more common in severe cases. Some cases showed a significant increase in white blood cells (11.0%), CRP increased (23.8%). 27 cases of severe children were etiologically checked, enterovirus 71 positive accounted for 70%, coxsackie virus A16 positive accounted for 15%. Bronchitis (93%), pneumonia (83%) and myocarditis (43%) in critically ill children. After symptomatic and antiviral treatment, 484 cases (96.4%) were cured and 2 died (all severe EV71-positive children). Hand, foot and mouth disease more common in children, the prevalence of common cases, the main symptoms of fever and rash, severe limbs and more patients with jitter, knee hyperactivity. As long as the early diagnosis, to the correct treatment, hand, foot and mouth disease prognosis is good.