摘要
目的总结危重症手足口病(4期)患儿的临床特点、治疗及预后。方法对我院2010年5月—2011年6月诊治的危重症手足口病(4期)患儿17例进行临床资料分析及随访。结果 17例患儿年龄为(19.8±11.1)个月,入院时病程为(3.2±0.8)d。其中肠道病毒71型(EV71)感染15例,柯萨奇病毒A16型(COA16)感染2例。影像学检查颅脑MRI阳性6例,CT阳性2例;脊髓MRI阳性2例。脑干听觉诱发电位示脑干受损14例,治疗上丙种球蛋白及甲泼尼龙免疫支持,维持血压、血糖及内环境稳定,行呼吸机支持治疗及头部亚低温治疗。家长放弃治疗5例(放弃时间分别为入院后1、3、7、30、50 d)。出院时完全治愈4例,遗留斜视(外展神经损害)3例,面瘫(面神经损伤)2例,吞咽功能障碍(舌咽神经损伤)2例,肢体活动功能障碍4例。另外1例治疗30 d无法撤离呼吸机转上级医院治疗。随访1年,吞咽功能损伤患儿恢复正常;外展神经受损患儿恢复正常;面神经损伤患儿1例恢复正常,另外1例患儿仍有轻微的闭眼困难;肢体活动障碍患儿有2例恢复正常。随访2年,面神经损伤患儿恢复正常;肢体活动障碍患儿剩1例仍有活动障碍,肌力恢复至4级;转上级医院治疗的患儿脱离呼吸机,可吞咽流质及半流质,可自行行走,肌力为4级。结论危重症手足口病(4期)为EV71感染多见,病情进展迅速,年龄以1.5岁为多,经积极综合治疗远期预后良好。
Objective To study the clinical features, treatment outcome and prognosis of critically ill pediatric pa- tients with hand, foot and mouth disease. Methods A total of 17 children with stage -4 hand, foot, and mouth disease were admitted and treated in our department between May 2010 and June 2011. Clinical features, treatment outcomes and prognosis were analyzed. Resu/ts The 17 patients aged （ 19. 8 ± 11. 1 ） months. They were admitted （3.2 ± 0. 8 ） days after the onset of the underlying disease. Enterovirus 71 （ EV71 ） infected was detected in 15 cases, and coxsackievirus A16 infection in the remai- ning 2 cases. Six eases were cranial MRI - positive, 2 cranial CT - positive, 2 spinal MRI - positive, and 14 auditory brainstem response - positive. Treatment with globulin and methyl prednisolone was effective in immune support, blood pressure and blood sugar control, and homeostatic maintenance of microenvironment. Five patients lost contact after their parents decided to give up treatment, respectively, on hospitalization day 1, 3, 7, 30 and 50. When discharged, 4 patients were completely cured, 3 with legacy strabismus （abducent nerve damage）, 2 with facial paralysis （facial nerve injury）, 2 with swallowing dysfunction （glossopharyngeal nerve injury）, and 4 with physical activity impairment. One patient required continuous mechanical ventilation even after 30 days of treatment and was treated t＇o a superior hospital. At one year postdischarge, the patients with swallowing dys- function and abdueens nerve damage respectively fully recovered. Of the 2 patients with facial nerve injury, one fully recovered, but the other was still experiencing difficulty in closing eyes. At 2 years postdischarge, one patient still had physical activity im- pairment and was transferred to a superior hospital. Conclusion EV71 infection is common in the most severe form of hand, foot and mouth disease. The condition develops and progresses fast, and most commonly affects 1.5 year - old children. The long - term prognosis is good after comprehensive integrated treatments.
出处
《中国全科医学》
CAS
CSCD
北大核心
2014年第4期403-407,共5页
Chinese General Practice
基金
中山市科技局重大项目立项:重症手足口病综合救治与机制研究(20101A008)
关键词
危重症手足口病
临床特点
随访研究
Severe hand, foot and mouth disease
Clinical features
Follow- up results studies
