摘要
目的了解手足口病死亡病例的临床特征与流行病学特征。方法对2008年5月至2011年9月浙江省72例手足口病死亡病例的人口学、诊治过程、临床症状和体征、实验室检测结果，以及流行病学接触史等信息进行分析。结果72例中男45例（62．5％），女27例（37．5％），平均年龄1．8岁，散居儿童63例（87．5％）。发热（98．4％，63／64）和皮疹（95．1％，58／61）常见，首诊皮疹多不明显，发热在皮疹之前（79．0％，49／62），平均持续4d。呕吐（71．9％，46／64）、呼吸困难（65．6％，42／64）、发绀（53．1％，34／64）和精神差（51．6％，33／64）比例高。病例就诊及时但误诊率高（82．5％，52／63），初诊医院平均需3d确诊，常在病后3～4d出现病情急剧恶化，住院后1d内（78．9％，45／57）死亡。34例（85．0％，34／40）白细胞增高，以中性粒细胞增高为主。病原学以肠道病毒71型为主（93．3％，56／60），常死于肺出血（42．9％，21／49）和脑炎（34．7％，17／49）。病例所处卫生环境差（65．5％，36／55），多无明确接触史（73．3％，33／45）。结论手足口病死亡病例常为肠道病毒71型感染，高热就诊但皮疹不典型，无明确接触史，易误诊，病情急剧恶化后，多在病后1周内死亡。
Objective To understand the clinical and epidemiological characteristics of hand-foot- and-mouth disease （HFMD） deceased cases. Method Information of demographics, diagnosis and treatment, clinical symptoms and signs, laboratory test results, and epidemiologieal contact history of 72 HFMD cases who died between May 2008 and September 2011, in Zhejiang Province, were collected and analyzed. Result The average age of the 72 cases was 1.8 years, 45 were males, accounting for 62. 5%, 63 （87.5%） of the cases were scattered children. Eighteen counties reported 2 or more deaths, accounting for 46. 1% （18/39） among the counties where the deaths were reported. The deaths occurred mainly in April to August, the peak occurred in May and June. Fever （98.4% ,63/64） and rash （95.1% ,58/61 ） were the most common symptoms, but the rash was not obvious at the first diagnosis. Fever occurred before the rash （ 79.0% , 49/62 ） , persisted for 4 days in average. Vomiting （ 71.9% , 46/64 ） , dyspnea （65.6% ,42/64 ）, cyanosis （ 53. 1%, 34/64 ） and impaired consciousness （ 51.6% , 33/64 ） were often seen among the eases; 53.1% （34/64） eases went to see the doctor on the first day, but 82. 5% （52/63） eases were misdiagnosed. Time to diagnosis of HFMD was in average 3 days. About 3 to 4 days after the onset, the disease deteriorated sharply, deaths occurred within 1 day after admission in 78. 9% （45/57）of the deceased eases; 85.0% （34/40） eases had high white blood cells level, mainly neutrophils increased, the ratio of neutrophil was more than 70% in 55.6% （ 15/27 ） of eases. Enterovirus 71 （ EV71 ） infection was found in 93.3% （56/60） eases, the deceased eases often died of pulmonary hemorrhage （42. 9% ,21/49） and encephalitis （34. 7% ,17/49）. The sanitary conditions of the eases＇ family were poor （65.5% ,36/ 55 ）, but 73.3% （ 33/45 ） eases had no exposure history. Conclusion The HFMD deceased eases were mostly younger aged boys, scattered children, nonloeal-residents, and had poor sanitation. They were ofteninfected with EV71, had high fever but had no typical rash, no clear exposure history, they had increased leukocyte, and were often misdiagnosed. Three or 4 days after onset, the disease deteriorated abruptly, most cases died within 1 week after onset. To decrease the HFMD mortality, early detection of severe cases should be stressed, and relative measures should be taken. The guardian should be aware of having good sanitary situation and healthy habits.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2013年第4期265-269,共5页
Chinese Journal of Pediatrics
关键词
手足口病
死亡
体征和症状
流行病学
Hand, foot and mouth disease
Death
Signs and symptoms
Epidemiology
