30例危重症和死亡手足口病临床分析

摘要

Objective:To analyze the death and critically ill cases of hand-foot-mouth disease(HFMD),to enhance the understanding of clinical characteristics and treatment of HFMD,and to improve success rate of rescue and lowering the mortality rate.Method:30 critically ill cases of HFMD(including 6 death)who were hospitalized in ICU of our hospital between March and June in 2012 with complete case materials were chosen as research objects.The age,sex,symptom,sign,lab result,treatment were retrospectively analyzed.Result:30 children included 22 males(73.3%) and 8 females(26.6%);the youngest was 5 months old while the oldest 8 years and 4 months.Every case was found fever,most cases showed weakness and sleepiness(91.6%-100%),irritation(83.3%-87.5%),cool limbs(62.5%-100%),increased blood pressure(66.6%-83.3%),rapid heart rate and respiratory(54.1%-100%).The death cases preferred to present cyanosis(100%),pink frothy sputum(83.3%),pulmonary rales(100%).60.0%-83.3%cases showed enterovirus EV71 positive. Conclusion:Of the 30 cases,all presented lesions of nerve system,mainly manifested by weakness, sleepiness,irritation,ataxia,short breath or changed rhythm,increased heart rate,cool limbs,increased blood pressure,cyanosis,pink frothy sputum,and pulmonary rales.EV71 was the main pathogen.Neurogenic pulmonary edema was the main cause of death.Early diagnosis,early giving complex therapy and rescue measure could significantly increase therapeutic effect.%　　目的：通过对手足口病危重症和死亡病例的分析，提高对该病临床特点和治疗的认识，旨在提高抢救成功率及降低死亡率.方法：选取2012年3-6月本院ICU收治的有完整病历资料的危重症手足口病30例(其中死亡6例)患儿为研究对象.采用回顾性分析法对其年龄、性别、症状、体征、实验室检查结果、治疗等进行分析.结果：30例患儿中，男22例(73.3%)，女8例(26.6%).最小5个月，最大8岁4个月.发热占100%，多数病例有精神差，嗜睡(91.6%~100%)，惊跳(83.3%~87.5%)，肢端冷(62.5%~100%)，血压高(66.6%~83.3%)，心率、呼吸快(54.1%~100%).死亡病例中更多出现口唇发绀(100%)、咳粉红泡沫痰(83.3%)、肺部啰音(100%).肠道病毒EV71阳性60.0%~83.3%.结论：30例病例全部出现神经系统损害，以精神差、嗜睡、惊跳、呼吸急促或节律改变、心率增快、肢端冷、血压升高、口唇发绀、咳粉红泡沫痰、肺部啰音等为主要表现.EV71为主要病原体.神经源性肺水肿为其主要死亡原因.早期诊断、早期给予综合治疗及抢救措施能显著提高疗效.