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目的探讨重症、普通住院和轻症手足口病临床表现及就诊过程中的影响因素,为手足口病防控和管理提供科学依据。方法采用统一设计的调查问卷,入户调查2011年宝山区报告的所有手足口病病例,对病人的临床表现和就诊情况进行分析。结果手足口病临床表现以皮疹(100%)和发热(38.20%)多见,15.56%可见有精神差、咳嗽、呕吐和手足抖动等其他症状。与轻症和普通住院病例比较,重症病例发热较早,发热持续时间长;其他症状和体征多在发病几日后出现,多见精神差、呕吐、四肢抖动、脑膜刺激征并伴有脑膜脑炎;EV71感染所占比例高。首诊医院中,区级及以下医院就诊率重症高于轻症(χ2=5.26,P<0.05),但确诊率重症低于轻症(χ2=9.47,P<0.05)。结论重症手足口病的主要病原为EV71型肠道病毒。重症病例早期症状不典型,区级及以下基层医院易误诊。建议开展基层医务人员手足口病诊治技术培训,提高对手足口病的诊断鉴别能力,正确识别重症手足口病的早期征象。
Objective To explore the clinical manifestations of critically ill patients, general hospitalization and mild hand-foot-mouth disease and the influencing factors during the treatment, and provide a scientific basis for the prevention and control of hand-foot-mouth disease. Methods A questionnaire of uniform design was used to investigate the cases of hand, foot and mouth disease reported by Baoshan District in 2011 and to analyze the clinical manifestations and treatment of the patients. Results The clinical manifestations of hand, foot and mouth disease were more common in skin rashes (100%) and fever (38.20%). 15.56% showed other symptoms such as poor spirits, cough, vomiting and hand-foot jitter. Compared with mild and common inpatient cases, severe cases of fever earlier, longer duration of fever; other symptoms and signs and more in the pathogenesis of a few days after the onset of more common mental retardation, vomiting, jitter limbs, meningeal irritation associated with meningoencephalitis ; EV71 infection accounted for a high proportion. The first visit to the hospital, district-level hospitals and the following hospitals were significantly higher than the severity of critically ill (χ2 = 5.26, P <0.05), but the diagnosis was less severe than mild (χ2 = 9.47, P <0.05). Conclusion The main pathogen of HFMD is EV71 enterovirus. Severe cases of early symptoms are not typical, the district level and below the primary hospital easily misdiagnosed. It is recommended to carry out the training of hand-foot-mouth disease diagnosis and treatment of grassroots medical staff to improve the diagnostic ability of hand-foot-mouth disease and correctly identify the early signs of severe hand-foot-mouth disease.