摘要
目的探讨危重症手足口病患儿的临床特点、治疗及预后。方法采用回顾性分析方法，记录并分析2010年4月至6月收治本院重症医学科（ICU）的13例危重症手足口病需呼吸机治疗患儿的临床资料，转入ICU后均予呼吸机正压通气治疗，同时适当限制液体量，维持循环稳定，合理应用脱水剂，保护脑细胞、心肌细胞，控制血糖平稳，糖皮质激素、丙种球蛋白冲击，合理使用抗菌药物等治疗。观察患儿治疗前后临床症状及体征、实验室检查、影像学改变及预后情况。结果13例患儿平均年龄（25．40±3．65）个月。治疗后患儿生命体征[体温（℃）、心率（HR，次／min）、呼吸频率（RR，次／rain）、收缩压（SBP，mmHg，1mmHg=0．133kPa）、舒张压（DBP，mmHg）]、氧合指数（PaO2／FiO2，mmng）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEII）评分（分）均较治疗前明显改善（体温：37．21±0．63比38．89±1．18，HR：116．91±30．57比186．27±25．88，RR：20．70±3．56比32．80±5．19，SBP：95．82±15．66比117．82±27．36，DBP：57．54±11．14比69．55±15．32，PaO2／FiO2：429．50±53．25比124．60±36．34，APACHEII：14．60±3．95比26．00±3．65，P〈0．05或P〈0．01），白细胞计数（WBC，×10^9）、肝功能、心肌酶、血糖（mmol／L）、C-反应蛋白（CRP，mg／L）均较治疗前明显降低[WBC：11．65±1．35比18．61±2．74，丙氨酸转氨酶（ALT，U／L）：18．50±10．93比51．82±26．80，天冬氨酸转氨酶（AST，U／L）：30．91±4．57比103．91±66．24，肌酸激酶同工酶（CK-MB，U／L）：24．54±5．75比48．73±14．90，肌酸激酶（CK，U／L）：79．55±17．17比244．36±67．72，乳酸脱氢酶（LDH，μmol·s^-1·L^-1）：4．33±1．60比7．60±2．45，血糖：6．40±2．27比14．77±6．24，CRP：1．95±0．35比8．44±1．52，均P〈0．01]，肾功能基本在正常范围内。x线胸片示肺实变影及渗出较治疗前消退，未发生新增实变影；3例心影增大患儿治疗后回缩至正常范围。13例患儿抢救成功11例，死亡2例。结论危重症手足口病病情进展迅速，应注重危重症患儿的早期识别，及时转入ICU积极治疗。
Objective To investigate the clinical characteristics, therapy and prognosis of eases with severe hand foot and mouth disease. Methods Thirteen patients with severe hand foot and mouth disease necessary for mechanical ventilation in intensive care unit （ICU） during April to June, 2010 were collected. A retrospective analytical method was applied to analyze the results. Positive pressure ventilation had been used in all patients after being transferred into ICU. Meanwhile, other therapies had been used, such as restriction of fluid volume, maintenance of stable circulation, proper use of dehydrant, protection of cerebral cells and myocardial cells, control of stable blood glucose （BG）level, intravenous impulsion injection of glucoeorticoid and γ-immunoglobulin, reasonable application of antibiotics, et al. The patients＇ clinical symptoms, physical signs, laboratory auxiliary examinations, the changes of ieonography and prognosis were observed before and after therapy. Results The mean age of 13 patients was （25.40±3.65）months. Compared with the indexes before therapy, the clinic targets such as vital signs ： body temperature （T, ℃ ）, heart rate （HR, bpm）, respiratory rate （RR, number of respiration per minute）, systolic blood pressure （SBP, mm Hg, 1 mm Hg = 0.133 kPa）, diastolic blood pressure （DBP, mm Hg）, oxygenation index （ PaO2/ FiO2, mm Hg ）, acute physiology and chronic health evaluation 11 （ APACHE I1 ） score were all improved obviously after therapy（T ： 37.21±0.63 vs. 38.89±1.18, HR ： 116.91±30.57 vs. 186.27±25.88, RR ： 20.70±3.56 vs. 32.80±5.19, SBP ： 95.82±15.66 vs. 117.82±27.36, DBP ： 57.54±11.14 vs. 69.55±15.32, PaOJFiO2 ： 429.50±53.25 vs. 124.60±36.34, APACHE II： 14.60±3.95 vs. 26.00±3.65, P〈0.05 or P〈0.01）. Values of auxiliary examinations, such as white blood cell count （WBC, × 10^9/L）, liver function, myoeardium creatase, BG （mmol/L）, C-reactive protein （CRP, mg/L）were all reduced markedly after therapy [WBC ： 11.65±1.35 vs. 18.61±2.74, alanine aminotransferase （ALT, U/L） ： 18.50± 10.93 vs. 51.82±26.80, aspartate transaminase （AST, U/L） ： 30.91±4.57 vs. 103.91 ±66.24, MB isoenzyme of ereatine kinase （CK-MB,U/L）： 24.54±5.75 vs. 48.73±14.90, creatine kinase（CK, U/L） ： 79.55±17.17 vs. 244.36±67.72, lactic acid dehydrogenase （LDH, μmol·s^-1·L^-1） ： 4.33±1.60 vs. 7.60±2.45, BG ： 6.40±2.27 vs. 14.77±6.24, CRP ： 1.95±0.35 vs. 8.44±1.52, all P〈0.01]. The renal function maintained within normal limits basically before and after therapy. Chest X-ray film showed that lung consolidation and exudation regressed and the enlarged cardiac image （podoid） in 3 patients was retracted back to normal range after therapy. There were 11 patients successfully rescued and 2 patients dead. Conclusion The disease situation of patients with severe hand foot and mouth disease deteriorates fast, so it is important to pay attention to identify early severe cases and shift them into ICU as soon as possible to get proper energetic treatment.
出处
《中国中西医结合急救杂志》
CAS
北大核心
2012年第2期100-103,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
基金项目：广西壮族自治区卫生厅科研项目（Z2010073）
关键词
手足口病
危重症
治疗
预后
Hand foot and mouth disease
Severe disease
Therapy
Prognosis
