重症手足口病机械通气147例临床特点及救治体会  

Clinical features and treatment of 147 cases with severe hand, foot and mouth disease receiving mechanical ventilation

作　　者：杨巧芝[1] 田辉[2] 梁珺[1] 董胜英[1] 刘志军[2] 

机构地区：[1]山东省聊城市人民医院儿科,252000 [2]山东省聊城市人民医院重症医学科,252000

出　　处：《中国小儿急救医学》2011年第1期30-32,共3页Chinese Pediatric Emergency Medicine

摘　　要：目的总结我院2009年1月113至9月6日收治重症手足口病机械通气患儿的临床特征及诊治经过，为减少神经源性肺水肿的发生及降低病死率提供依据。方法采用回顾性分析方法对147例重症手足口病机械通气患儿的相关信息进行分析。结果85．0％患儿年龄在3岁以下；100％患儿发热；发热至机械通气时间1～4d，平均（3．06±1．02）d；神经系统并发症表现为精神差、易惊、肢体抖动、嗜睡；呼吸系统表现为呼吸急促、浅慢、节律不规则；循环系统表现为心率增快或减慢、血压增高或降低、皮肤花斑、四肢皮温低。部分病例出现血白细胞、血糖、血乳酸升高，咽拭子EV71-PCR阳性率34．7％，肛拭子EV71．PCR阳性率42．2％。X线胸片表现为肺纹理增粗、渗出或无明显异常。机械通气患儿死亡3例，病死率为2．0％。结论本次手足口病流行病情相对重，变化快，并发神经源性肺水肿治疗困难，病死率高。早期识别重症患儿，及时机械通气，并给予综合治疗，可减少神经源性肺水肿的发生，降低病死率。Objective To summarize the clinical features, diagnostic and treatment experience of severe hand,foot and mouth disease（HFMD） cases receiving mechanical ventilation from Jan 1 to Sep 6,2009 in our hospital and provide reference for reducing the occurrence of neurogenic pulmonary edema（NPE） and mortality. Methods 147 severe HFMD who received mechanical ventilation were analyzed by a retrospective investigation. Results 85.0% children were less than 3 years old and 100% patients had a fever. The mechanical ventilation occurred within 1 to 4 days after fever （ 3.06 ± 1.02 ） d. Neurological complications pres- ented as bad spirit, easy surprised, involuntary movement of the extremities and lethargy. Respiratory system complication presented as polypnea, hypopnea and irregular rhythm. Circulatory system complication presented as heart rate increase or decrease, hypertension or hypoteusion, piebald skin and low limb temperature. Some of the children had high white blood cell counting,glucose and lactic acid of the blood. The EV71-PCR positive rate was 34. 7% for throat swabs,and 42. 2% for anal swabs. Chest X-ray presented as increased broncho vascular shadows, exudation or nonapparent abnormality. Only three children were dead, fatality rate was 2. 0%. Conclusion The HFMD cases in this outbreak are relatively more serious ,and change rapidly. It＇s difficult to treat as soon as NPE appeared,and it has high fatality rate. Early recognition of critical patients,timely giving mechanical ventilation, and the comprehensive treatment can reduce NPE incidence and the morality.

关 键 词：重症手足口病 机械通气 EV71 

分 类 号：R725.1[医药卫生—儿科]