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目的探讨重症手足口病(HFMD)的临床特点和实验室检查指标,分析神经系统早期病变的特征及危重型病例的危险因素,以利于疾病早期诊断和治疗,降低病死率。方法对本院重症监护室2010年3月-2011年6月收治的70例重症HFMD患儿的临床资料进行回顾性分析,根据临床特征将70例患儿分为重型组和危重型组,比较2组神经系统、呼吸和循环系统的表现及实验室检查的差异。Logistic回归分析进展为危重型HFMD的危险因素。结果 70例重症HFMD患儿中,男43例,女27例;<3岁55例(78.6%);重型组41例(58.6%),危重型组29例(41.4%)。高热(≥39℃)38例(54.3%),典型皮疹50例(71.4%)。神经系统主要表现:精神差59例(84.3%),惊跳51例(72.9%),意识障碍38例(54.3%),肢体震颤31例(44.3%),呕吐24例(34.3%),膝反射异常41例(58.6%);呼吸和循环系统表现:呼吸浅快11例(15.7%),呼吸节律不规则15例(21.4%),肺水肿18例(25.7%),心率增快28例(40.0%),血压升高14例(20%),出汗8例(11.4%),毛细血管充盈时间(CRT)>5 s 11例(15.7%);血白细胞>12×109L-138例(54.3%),血糖>6 mmol.L-139例(55.7%)。危重型组在肢体无力、意识障碍、抽搐、膝反射减弱/消失、肌张力降低、呼吸浅快、呼吸节律不规则、心率增快、血压升高、出汗、CRT>5 s、高血糖、不典型皮疹的发生率方面明显高于重型组,差异均有统计学意义(Pa<0.05)。多因素Logistic回归分析发现,意识障碍、呼吸节律不规则、心率增快、高血糖、不典型皮疹是进展为危重型HFMD的危险因素。结论精神差、惊跳、意识障碍、肢体震颤、呕吐、膝反射异常是神经系统早期病变的表现;意识障碍、呼吸不规则、心率增快、高血糖、不典型皮疹是进展为危重型HFMD的危险因素。
Objective To investigate the clinical features and laboratory tests of severe hand-foot-mouth disease (HFMD) and analyze the characteristics of early-stage nervous system diseases and risk factors of critical-type cases in order to facilitate the early diagnosis and treatment of diseases and reduce the mortality. Methods The clinical data of 70 severe HFMD children admitted to our intensive care unit from March 2010 to June 2011 were retrospectively analyzed. According to the clinical characteristics, 70 children were divided into severe group and severe group. Neurological, respiratory and circulatory manifestations in the 2 groups and differences in laboratory tests. Logistic regression analysis of risk factors for the development of critically ill HFMD. Results Seventy patients with severe HFMD had 43 males and 27 females, 55 cases (78.6%) under 3 years old, 41 cases (58.6%) with severe cases and 29 cases (41.4%) with severe cases. High fever (≥39 ℃) in 38 cases (54.3%), typical rash in 50 cases (71.4%). The main manifestations of the nervous system were as follows: 59 cases (84.3%), 51 cases (72.9%), 38 cases (54.3%) of consciousness, 31 cases of tremor (44.3%), 24 cases (34.3% Breathing and circulatory system manifestations were as follows: fast respiration in 11 (15.7%), irregular respiratory rhythm in 15 (21.4%), pulmonary edema in 18 (25.7%), and heart rate increased in 28 (40.0%), elevated blood pressure in 14 patients (20%), sweating in 8 patients (11.4%), capillaries filling time more than 5 s in 11 patients (15.7%) and white blood cells> 12 × 109L- (54.3%), blood glucose> 6 mmol.L-139 cases (55.7%). Critically ill patients had weakness, disturbance of consciousness, convulsions, decreased / disappearance of knee reflex, decreased muscle tone, shallow breathing, irregular respiratory rhythm, increased heart rate, elevated blood pressure, sweating, CRT> 5 s, hyperglycemia, The incidence of atypical rashes was significantly higher than that of the severe group (P <0.05). Multivariate Logistic regression analysis found that disturbance of consciousness, irregular respiratory rhythm, rapid heart rate, hyperglycemia and atypical rash were the risk factors for progressing to critical HFMD. CONCLUSIONS: Poor mental performance, disturbances of consciousness, limb tremor, vomiting and abnormal knee reflexes are manifestations of early nervous system disorders. Disorders of consciousness, irregular breathing, increased heart rate, hyperglycemia, and atypical rashes progress to critically ill HFMD Risk factors.