342例重症手足口病患儿的临床特征分析  

Clinical characteristics analysis of 342 children with severe hand-foot-mouth disease

作　　者：王庆圆 徐洪波 田茂强 马一翔 幸黔鲁 陈艳 WANG Qingyuan;XU Hongbo;TIAN Maoqiang(Pediatrics,the first Clinical College,Zunyi Medical University,Zuiyi(563000),Guizhou,China)

机构地区：[1]遵义医科大学第一临床学院儿科学,贵州遵义563000 [2]遵义医科大学附属医院小儿内科,贵州遵义563000 [3]遵义医科大学第二附属医院小儿内科,贵州遵义563000

出　　处：《癫痫与神经电生理学杂志》2024年第3期160-166,共7页Journal of Epileptology and Electroneurophysiology(China)

基　　金：贵州省科技计划项目(黔科合基础[2020]1Y351)。

摘　　要：目的探讨重症手足口病(HFMD)患儿的临床特征并对其高危因素进行分析。方法回顾性分析2018年6月至2022年6月在遵义医科大学附属医院住院治疗的342例重症HFMD患儿的临床资料、病原学相关指标及治疗情况,根据患儿神经系统受累后是否发生心肺功能衰竭分为Ⅰ组(HFMD并神经系统损害,有心肺功能衰竭)和Ⅱ组(HFMD并神经系统损害,无心肺功能衰竭),两组间进行基线资料比较。结果纳入342例重症HFMD患儿,其中男性214例,女性128例。中位年龄为17(12,24)个月。中位住院时间为5(5,6)d。发病具有明显季节性,高峰期为5~9月。其中Ⅰ组13例,Ⅱ组329例,Ⅰ组患儿年龄更小,住院时间更长(P<0.05)。重症HFMD患儿的临床表现以发热、皮疹常见,同时伴神经系统症状,部分患儿伴有呼吸系统及循环系统受累。重症HFMD患儿的病原学以其他肠道病毒感染常见,两组患儿病原学资料比较,EV71与其他病原学差异有统计学意义(P<0.001)。重症HFMD患儿的治疗以降低颅内压、免疫调节及营养支持等综合治疗为主,累及心肺功能的患儿可联合血管活性药物及呼吸机治疗。结论重症HFMD以男性患儿多见,年龄≤3岁,发病高峰季节为5~9月。临床表现多样,危重症更易导致患儿脑干损伤及出现气促、心动过速及肺出血等。应加强对重症HFMD患儿病原学的检测,尤其EV71感染后可导致严重并发症。重症HFMD患儿早期应用糖皮质激素联合静脉用人免疫球蛋白治疗十分重要。Objective To investigate clinical characteristics of children with severe hand-foot-mouth disease(HFMD)and explore risk factors for severe HFMD.Methods A retrospective analysis was conducted on clinical data,pathogens-related indicators and treatment status of children with severe HFMD who were hospitalized at Zunyi Medical University Affiliated Hospital from June 2018 to June 2022.Based on whether the children experienced cardiopulmonary failure after their neurological system was involved,they were divided into GroupⅠ(HFMD children with neurological damage and cardiopulmonary failure)and GroupⅡ(HFMD children with neurological damage but no cardiopulmonary failure).Baseline data were compared between two groups.Results Among 342 children with severe HFMD,there were 214 males and 128 females.The median age was 17(12,24)months,and the median hospitalization time was 5(5,6)d.The onset of HFMD was obvious seasonality,with a peak from May to September.There were 13 cases in GroupⅠand 329 cases in GroupⅡ.The children in GroupⅠwere younger than those in GroupⅡand had longer hospital stays than GroupⅡdid(P<0.05).The clinical manifestations of the children with severe HFMD were commonly fever and rash accompanied by neurological symptoms,and some of them were accompanied by respiratory and circulatory system involvement.Severe HFMD etiology was commonly caused by other enterovirus infections.The etiology between two groups of children was compared,showing that there was a statistical difference between EV71 and other pathogens(P<0.001).Main therapy for children with severe HFMD was comprehensive treatments such as lowering intracranial pressure and regulating immunity and nutritional support.The children with cardiopulmonary dysfunction were treated with a combination of vasoactive drugs and mechanical ventilation.Conclusion Severe HFMD is common in male pediatric patients,with age≤3 years old and a peak onset season from May to September.The clinical manifestations are diverse,and critically ill children

关 键 词：手足口病 重症 神经系统 心肺衰竭 儿童 临床特征 病原学 

分 类 号：R512.5[医药卫生—内科学]