目的 探讨手足口病及其并发症的临床特征及病原学特点.方法 收集2012年4月至2014年10月青岛市妇女儿童医院住院的重症手足口病患儿(≥2期)血清标本556例.其中328例血清肠道病毒(enterovirus,EV)71型扩增为阳性,112例CoxA16型特异引物扩增为阳性,116例为其他型手足口病患儿.EV71型重症手足口病住院患儿328例的完整临床资料,分析其临床表现、辅助检查、并发症、临床治疗及转归.结果 328例患儿均有皮疹,病程中出现发热(97.87%)、惊厥(67.07%)、肢抖(58.23%)、呕吐(31.40%)、嗜睡(14.94%)、抽搐(3.96%)、头痛(46.34%)、意识障碍(0.61%)、胸片提示神经源性肺水肿(3.05%)、肺出血(0.61%)、需要呼吸支持(7.00%).除2例死亡外,其余均治愈或好转出院.随诊1~2年,仅有1例患儿存在运动障碍未完全恢复,1例患儿存在癫痫,药物可控制,其余未留有后遗症.结论 EV71型手足口病易合并中枢神经系统感染、神经源性肺水肿、肺出血等严重并发症,早期诊断、早期治疗有助于降低患儿死亡率和减少并发症,提高治愈率.%Objective To learn the clinical and pathogenic character of the hand-foot and mouth disease and its complications.Method The children of Women's and Children's Hospital of Qingdao City from April 2012 to October 2014 were severe HFMD (more than 2). Serum samples of 556 cases including 328 cases of serum enterovirus type 71 (enterovirus, EV) were positive, 112 cases of CoxA16 type specific primers were positive, 116 cases of other HFMD cases. The clinical data of 328 cases with HFMD and severe viral encephalitis whose pathogenic detection were EV71 were retrospectively analyzed.Result All of the cases had rash, and main clinical characters included: fever(97.87%), convulsions(67.07%) shake(58.23%), vomit(31.40%), sleepiness(14.94%), twitch (3.96%), headache (46.34%), disturbance of consciousness(0.61%), neurogenic pulmonary edema showed by X-ray(3.05%), pulmonary hemorrhage(0.61%), respiratory support(7.00%). Except 2 died cases, others were better or cure. After 1-2 years following-up, there was only one case had movement disorder unrecovered, and one case had epilepsy, which could be controlled by drugs. Others had no sequela.Conclusion The hand foot and mouth disease caused by EV71 can easily lead to infection of central nervous system, neurogenic pulmonary edema, pulmonary hemorrhage, and other severe complications. Early diagnosis and treatment can help to reduce mortality and complications, and help to improve the cure rate.
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