论文部分内容阅读
目的探讨重型手足口病的临床特点,以总结救治经验。方法回顾性分析我院2011年1月—2012年12月收治的484例手足口病的临床表现和治疗情况。结果本组患儿男女比为1.5∶1,年龄(2.17±0.60)岁,病程(2.74±1.19)d,住院天数(6.14±1.78)d。临床症状和体征主要有手和(或)足部皮疹(100%)、精神差(98.1%)、发热(95.7%)、惊跳(95.7%)、激惹(94.4%)、心率加快(81.8%)、呕吐(40.1%)、血压升高(36.6%)和肢体抖动(33.9%)。实验室检查异常指标主要有白细胞计数升高(60.1%)、心肌损伤(38.0%)、血糖升高(32.9%)、血乳酸升高(31.0%)。脑脊液检查为病毒性脑炎改变,脑部CT/MRI检查均未见异常。病原学检查以EV71感染为主(65.1%)。经抗病毒和对症治疗,应用静脉免疫球蛋白(intravenous immunoglobulin,IVIG)、米力农(甲氰吡酮)、甘露醇和地塞米松等治疗后,所有患儿均痊愈出院,无一例转为危重型。结论重型手足口病早期临床表现较隐匿,精神差、惊跳、激惹为神经系统最主要表现。早期诊断并及时应用甘露醇和地塞米松,血压升高时及时应用米力农,血糖和白细胞明显升高时酌情应用IVIG,则预后良好。
Objective To investigate the clinical features of HFMD in order to summarize the experience of treatment. Methods The clinical manifestations and treatment of 484 hand, foot and mouth disease in our hospital from January 2011 to December 2012 were analyzed retrospectively. Results The ratio of male to female in this group was 1.5: 1 (2.17 ± 0.60) years, duration of disease (2.74 ± 1.19) days and hospitalization days (6.14 ± 1.78) days. The main clinical symptoms and signs were hand and / or foot rash (100%), poor spirit (98.1%), fever (95.7%), jerking (95.7%), irritation (94.4%) and heart rate %), Vomiting (40.1%), elevated blood pressure (36.6%) and limb jitter (33.9%). Abnormal laboratory tests were mainly white blood cell count (60.1%), myocardial injury (38.0%), elevated blood sugar (32.9%), elevated blood lactate (31.0%). Cerebrospinal fluid examination for the change of viral encephalitis, brain CT / MRI examination showed no abnormalities. The etiological examination was predominantly EV71 (65.1%). After antiviral and symptomatic treatment, all patients were cured and discharged after intravenous immunoglobulin (IVIG), milrinone, mannitol and dexamethasone treatment, and none of them were changed to critically ill type. Conclusion The clinical manifestations of severe HFMD are more obscure, poor in spirit, more alarming and more irritating. Early diagnosis and timely application of mannitol and dexamethasone, when the blood pressure and timely application of Milrinone, blood glucose and leukocyte significantly increased when appropriate, the application of IVIG, the prognosis is good.