阜阳市重症手足口病致神经源性肺水肿23例  

Clinical Analysis of 23 Cases of Severe Hand,Foot and Mouth Disease with Neurogenic Pulmonary Edema in Fuyang City

作　　者：李志奇[1] 徐国成[1] 韩明锋[2] 李秀勇[2] 冉献贵[2] 胡茂庆[1] 张怀伟[2] 郭君[3] 

机构地区：[1]皖南医学院附属弋矶山医院儿内科,安徽芜湖241001 [2]阜阳市第二人民医院呼吸科,安徽阜阳236015 [3]淮南东方医院儿科,安徽淮南232001

出　　处：《实用儿科临床杂志》2009年第18期1403-1405,1408,共4页Journal of Applied Clinical Pediatrics

基　　金：安徽高校自然科学研究项目资助(KJ2009B290Z)

摘　　要：目的分析重症手足口病致神经源性肺水肿患儿的临床表现,总结其诊断依据,探讨其有效的治疗方法。方法采用回顾性分析的方法对阜阳市第二人民医院收治的23例重症手足口病致神经源性肺水肿病例的相关信息进行分析,包括临床表现、血常规、血生化检查、病原学检测、脑脊液和X线胸片检查。4月20日前收治的6例患儿予常规抗炎、强心等综合治疗;4月20后,17例患儿予降颅压,大剂量甲泼尼龙及丙种球蛋白冲击治疗或机械通气治疗。结果本组病例多发生于3岁以下儿童,多有发热,神经系统、呼吸系统、循环系统发生病理生理改变,多数病例出现血白细胞、血清CK、血清CK-MB、血糖、CRP、血小板计数升高。脑脊液检查提示无菌性炎性反应。胸片提示进展迅速的肺实变影。行病原学检测7例患儿中,5例EV71病毒呈阳性,占71.42%。尸检显示肺组织淤血、水肿、出血,支气管黏膜可见中性粒细胞浸润;中枢神经系统则表现为脑炎、脑膜炎和脊髓炎。4月20前6例未行机械通气治疗患儿均于入院10 h左右死亡;4月20日后治疗17例患儿中,9例临床治愈,4例自动出院,4例死亡。结论重症手足口病致神经源性肺水肿起病急、发展迅速、病死率较高。机械通气、脱水降颅压、大剂量激素和静脉用丙种球蛋白冲击治疗可改善预后,抢救的关键在于早期发现和正确处理。Objective To analyze the clinical features of neurogenic pulmonary edema （NPE） caused by severe hand, foot and mouth disease（ HFMD）, and summarize the diagnostic evidences and explore the effective therapy. Method A retrospective analysis of 23 severe HFMD cases with NPE was performed who were admitted into the fuyang second hospital,including clinical manifestation, routine detection, biochemistry detection,etiology detection, cerebrospinal fluid （ CSF）, chest X - ray film, and treatment, prognosis. Results Most patients were below 3 years old, fever and pathologic changes in nervous, respiratory and circulation system were common. Most cases had a high level of white blood cell count,CK, CK- MB, glucose, CRP, and blood platelet count in peripheral blood. There was aseptic inflammation in cerebrospinal fluid, and X - ray of chest showed rapid progress of consolidation of lungs. Among 7 cases who had accepted etiologic detection, enterovirus 71 （ EV71 ） was found in 5 cases （71.42 % ）. Congestion, edema, and hemorrhage of lung, neutrophil infiltrating within tunica mucosa bronchiorum could be seen when autopsy. Pathological changes of central nervous system were encephalitis, meningitis, and myelitis. Six patients without mechanical ventilation （MV） treatment before 20. Apr were died at 10h after hospitalized ; in 17 cases who were treated after 20. Apr,9 cases were clinical cured ,4 cases died. Conclusions NPE caused by severe HFMD was characteristic of urgent onset, rapid progression and high mortality. Comprehensive therapy including mechanical ventilation, anhydration, flushing dose of glueocorticoids and immunoglobulin intravenously and improving haemodynamies may be helpful for progressive patients. The key of rescue lays in detecting and correcthandling early.

关 键 词：手足口病 肠道病毒71 神经源性肺水肿 

分 类 号：R725.1[医药卫生—儿科]