手足口病并发脑脊髓炎63例临床分析  

作　　者：胡静[1] 石小华[1] 田野[1] 叶宁[1] 

机构地区：[1]南京医科大学附属南京儿童医院,210008

出　　处：《浙江临床医学》2012年第11期1352-1354,共3页Zhejiang Clinical Medical Journal

摘　　要：目的研究手足15病并发脑脊髓炎的临床和检验检查特点，以提高诊治水平。方法对63例手足口病并发脑脊髓炎患儿的临床资料进行回顾性分析及随访研究。结果发病年龄1～11岁，平均（3．36±1．13）岁。肢体活动障碍59例（93．7％），脑脊液常规异常63例（100％），脑脊液蛋白升高20例（31．7％）平均住院日为（16．8±1．94）d，较脑脊液蛋白正常患儿平均住院13长。磁共振异常45例（71．4％），以脑桥或脊髓斑片状及条状长T1、长T2信号为主。脑电图异常30例（47．6％），肌电图检查四肢神经传导异常40例（63．5％），提示F波出波率低。63例均予激素治疗，60例同时合用大剂量人血丙种球蛋白，疗效显著，所有患儿均好转。经6个月随访，1例左下肢稍有跛行，54例恢复正常，8例失随防。结论脑脊髓炎是重症手足口病中枢神经系统损害的表现之一，好发年龄3～4岁。脑脊液、MRI、肌电图检查四肢神经传导功能，有助于早期诊断。脑脊液蛋白升高提示恢复慢、住院时间长。糖皮质激素及大剂量丙种球蛋白有一定疗效，预后良好。Objective To explore characteristics of hand foot mouth disease complicated with encephalomyelitis, including clinical, physical and chemical examination. Methods Retrospective analysis the datum of 63 patients who had hand foot mouth disease complicated with encephalomyelitis from May 2008 to November 2011, and investigate the long-term outcome. Result Average age of patients was （ 3.36±1.13 ）. （ from 1 year to llyears old. 59 （ 93.7% ） patients with limb movement disorder. 63 （ 100% ） patients with WBC increasing in cerebral spinal fluid （ CSF ） . 20 （ 31.7% ） patients with protein level rising in CSF, average duration in hospital was （ 16.8 ± 1.94 ） days, longer than those patients who with normal protein level in CSF. Neurologic MR/of 45 patients （ 71.4% ） were abnormal, the primary location of lesion was dorsal pons and spin, Plain T1-weighted images showed hypointense signals, or T2-weighted images showed hyperintense signals. 30 （ 47.6% ） patients with abnormal EEG, Extremities nervous conduction was abnormal and F wave frequency decreased in 40 patients （ 63.5% ） , glucocorticoid were administered in 63 patients, meanwhile high dosage immunoglobulin was given to 60 patients, determine efficacy was obtained, all of the patients became better. After 6 months investigation, only 1 patient had crippling of left leg, 54 patients recovered, 8 patients was lost. Conclusions Encephalomyelitis is the manifestation of the CNS damage in hand foot mouth disease, ncurolymph, MRI and electromyography help to an early diagnose. The increase of protein in the ncurolymph show a slow recovery and longer hospital stay. Glucocorticoids and large dose of immunoglobulin is effective.

关 键 词：手足口病 脑脊髓炎 临床分析 肠道病毒 

分 类 号：R744.3[医药卫生—神经病学与精神病学]