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目的分析研究重型及危重型手足口病多脏器损害的发生机制,总结及探讨抢救经验。方法所有重型及危重型患者入院后在应用基础药物的同时马上启用多巴胺2～5μg/(kg.min)、酚妥拉明2～5μg/(kg.min),持续24 h血管内泵入连续数天;凡有:①体温>38℃;②惊跳;③震颤;④抽搐一项者加用氯丙嗪、异丙嗪各1 mg/kg每次,每4～6小时1次血管注入连续数天至上述症状消失;四肢冰冷、精神萎靡、休克者于1 h内注入盐水15～20 ml/kg,必要时重复1次,持续应用多巴胺6μg/(kg.min),不用酚妥拉明与氯丙嗪、异丙嗪;肺部广泛湿啰音者调整酚妥拉明与多巴胺比例。结果 187例重型及28例危重型患者中的24例疾病进展迅速得到中止及逆转。治疗结果全部治愈。无一例需插管上呼吸机,无一例死亡,抢救效果满意。4例送达时已是危重型终末期患儿,尽管立即应用呼吸机仍无法存活。结论增加血管活性药物能有效中止与逆转所有重型患者及危重型早中期患者的病情进展,但对终末期危重型患者无效。
Objective To analyze the mechanism of multiple organ damage in severe and critically ill hand-foot-mouth disease and to summarize and explore the experience of emergency treatment. Methods All patients with severe and critically ill type 2 were given dopamine 2 ~ 5μg / (kg · min) and phentolamine 2 ~ 5μg / (kg · min) at the same time of application of basic drugs, A few days; where: ① body temperature> 38 ℃; ② jumped; tremor; ④ convulsions plus chlorpromazine, promethazine each 1 mg / kg every 4 to 6 hours a vessel injection For several days to the above symptoms disappear; cold limbs, apathetic, shock were injected within 1 h saline 15 ~ 20 ml / kg, if necessary, repeated 1 times, continuous application of dopamine 6μg / (kg.min), without Phentola Ming and chlorpromazine, promethazine; pulmonary wet rales who adjust the phentolamine and dopamine ratio. Results Twenty-four of the 187 heavy and 28 critically ill patients were rapidly discontinued and reversed their disease. Therapeutic results are all cured. No need to intubation on the ventilator, no one died, the rescue effect is satisfactory. Four patients were already critically ill end-stage children, although the ventilator was not immediately available for survival. Conclusions The increase of vasoactive drugs can effectively halt and reverse the progression of the disease in all heavy and critical early-mid-stage patients, but is not effective in end-stage critically ill patients.