EV71型手足口病并发脑炎重症病例临床分析  

Clinical Analysis of the Severe Cases with EV-71 Hand,Foot and Mouth Disease and Viral Encephalitis

作　　者：李侗曾[1] 张宏伟[1] 梁连春[1] 

机构地区：[1]首都医科大学附属北京佑安医院感染科,100069

出　　处：《医学研究杂志》2013年第3期143-146,共4页Journal of Medical Research

摘　　要：目的研究肠道病毒71型(EV71)导致的手足口病并发脑炎重症病例的临床和实验室特点,以提高临床诊治水平。方法对笔者医院2011年5月～2012年1月收治的164例咽拭子EV71核酸检测阳性的手足口病并发脑炎重症患儿临床资料进行回顾性分析,将其分为重型组和危重型组,包括临床特征、实验室检查和治疗、转归情况。结果 164例患儿均有发热和皮疹。与重型组比较,危重型组中肌无力、抽搐、躁动症状的发生率较高,WBC、心肌受损相关指标(CK、CKMB、LDH、HBDH)、血糖及PCO2水平也明显升高。治疗上应积极采用甘露醇降颅内压(93.3%),酌情联合糖皮质激素(63.4%)及丙种球蛋白(15.9%)治疗,此外笔者医院重症病例通常加用鼠神经生长因子(72.6%)营养神经,匹多莫德(71.3%)提高免疫力。164例重症患儿中治愈好转158例,因病情危重自动出院1例,死亡5例。结论 EV71型HFMD并发脑炎重症患儿病情凶险,病死率高,需早期诊断、早期干预及细心护理,以提高治愈率,降低病死率。Objective To reaearch the clinical and laboratory characteristics of severe cases with EV -71 hand,foot and mouth dis- ease（HFMD） and viral encephalitis, so that to improve the diagnosis and therapy of the disease. Methods Retrospective analysis was made on the clinical data of 164 severe cases of EV -71 HFMD and viral encephalitis. Results All 164 cases had fever and rash. Com- pared with severe group, the incidence of myasthenia, convulsions and restlessness among critical group were higher. The level of WBC, myocardial damaged related index （CK, CKMB, LDH, HBDH） , blood sugar and PCO2 also increased significantly. Treatment should take measares actively with mannitol to reduce intracranial pressure（93.3% ） , combined appropriately with glucocorticoid（63.4% ） and gamma globulin （15.9%）. In addition,we used mouse nerve growth factor （72.6%） and pidotimod（71.3% ） in severe cases. In all 164 severe cases, 158 cases cured or were improved, lease gave up treatment and 5 cases died. Conclusion Severe cases with EV -71 HFMD and viral encephalitis are dangerous, with a high mortality rate. Early detection, early intervention and careful nursing will improve the success rate and reduce the mortality of rescue.

关 键 词：手足口病 EV71型 脑炎 临床分析 

分 类 号：R512.5[医药卫生—内科学]