214例重症手足口病并发脑炎患儿临床特征及病原学分析  

Clinical character and etiology analysis of 214 severe hand, foot and mouth disease children with complicating encephalitis

作　　者：柳琼[1] 王美芬[1] 廖亚彬[1] 杜曾庆[1] 王艳春[1] 

机构地区：[1]昆明市儿童医院感染科,650034

出　　处：《国际流行病学传染病学杂志》2012年第1期17-20,共4页International Journal of Epidemiology and Infectious Disease

摘　　要：目的总结重症手足口病（}IFMD）并发脑炎患儿的临床特征及病原学分析。方法对我院2011年6月收治住院的279患儿中的214例重症HFMD并发脑炎患儿积极给予甘露醇脱水降颅压、短期应用激素，抗感染、对症支持治疗。31例危重型患儿给予吸氧、米力农、酚妥拉明治疗。危重型病例及病情较重的重症病例49例加用丙种球蛋白治疗。6例呼吸、循环衰竭患儿应用机械通气。粪便RT-PCR核酸检测213例。结果279例中重症患儿214例，占76．70％；男女比例1．55：1；城乡比1：1．24；212例患儿发热，入院时平均热程2．91d，热度在39．40℃169例（79．72％）。所有患儿均出现HFMD典型皮疹。患儿主要表现为膝腱反射亢进199例（92．99％）、颈抵抗191例（89．25％）和易惊166例（77．57％）等。所以患儿均有脑脊液异常。212例患儿治愈出院；2例下肢瘫痪患儿病情明显好转出院，随访2周后治愈。本组病例平均住院时间7．43d（5～18d）。213例粪便送检检出病原200例（93．90％），其中191例为EV71，占检出病原的95．50％。结论本院收治的患儿重症的比例较高，对于危重型患儿，积极给予酚妥拉明、米力农治疗，积极降低颅内压力及抗感染治疗可最大限度降低病死率和致残率。EV71仍是HFMD的主要致病病原。Objective To summarize clinical feature of severe hand, foot and mouth disease （HFMD） complicating encephalitis and analyze its pathogens. Methods A total of 214 severe HFMD cases complicating encephalitis hospitalized children in June 2011 in our hospital were entrolled in 279 HFMD cases. 214 cases were given milrinone to decrease intracranial pressure. Hormone and antivirus drug were applied in a short-term to resistance the infection, and other adjuvant therapy. 31 critical cases were given the oxygen, milrinone and phentolamine during the treatment. 49 cases who were critical cases or more severe cases were give intravenous immtmoglobulin, 6 cases combined with respiratory and circulatory failure and applied the mechanical ventilation. Excrement etiology of 213 cases were detected by RT-PCR. Results In 279 patients, of 214 cases were severe HFMD, account for 76.70%. The proportion of male and female was 1.55：1. The ratio of urban and rural area was 1 ： 1.24. There were 212 cases had fever and the mean course of fever before going to hospital was 2.91 days. The temperature of 169 cases were 39-40℃（79.72%）. All the patients had HFMD typical rashes. The main menifestations were knee jerk reflex hyperfunction（ 199 cases, 92.99% ）, neck resis-tance （ 191 cases, 89.25 % ）, and easy to panic（ 166 cases, 77.57 % ）, cerebrospinal fluid of all patients were abnormal. 212 patients were cured, 2 cases with acute flaccid paralysis of lower extremity had significantly better on discharge and continued to use prednisone and a variety of vitamins, and were cured when following up for 2 weeks. The average hospitalization time was 7.43 days（5-18 days）. 200 cases were detected enteric virus in 213 cases （93.90%）, in which EV71 were 191 cases （95.50%）. Conclusions A higher proportion of severe HFMD patients are admitted in our hospital. To the critical cases, phenollamin and milrinone should be given as soon as possible. Actively reducing the intracranial pressure and anti-infection treatmen

关 键 词：手足口病 重症病例 病原学 

分 类 号：R725.1[医药卫生—儿科]