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目的探讨2009年及2010年西安地区危重症手足口病(HFMD)的流行特点。方法对2009年及2010年本院收治的46例(2009年12例,2010年34例)危重症HFMD的一般资料、症状、体征、辅助检查、呼吸机参数以及转归进行比较和回顾性分析。结果 2010年危重症病例数与2009年比较有明显上升趋势,死亡比例自66.7%降至41.2%;皮疹分布较2009年广泛,累及器官数目有所减少;热程、病情转危时间、神经系统受累时间均无明显变化;发生抽搐、脑干脑炎、肺出血及应激性溃疡的比例亦未增加;辅助检查包括血糖、白细胞、CK-MB、心电图及X线影像异常比例差异均无统计学意义,早期行MRI检查阳性率高;呼吸机治疗参数PIP及PEEP值、治愈患儿平均上机时间及住院日、治愈率比较均无统计学意义。结论近2 a西安地区危重症HFMD的流行病学及临床特点及治疗策略均未发生明显变化,对于危重症HFMD患儿,必须采取“关口前移”的预防干预措施才能有效降低病死率。
Objective To investigate the prevalence of critically ill hand-foot-mouth disease (HFMD) in Xi’an in 2009 and 2010. Methods The data, symptoms, signs, auxiliary examinations, ventilator parameters and prognosis of 46 HFMD patients (12 in 2009 and 34 in 2010) admitted to our hospital in 2009 and 2010 were compared and retrospectively analyzed . Results In 2010, the number of critically ill patients increased significantly from 2009 to 2009, with the proportion of deaths falling from 66.7% to 41.2%. The distribution of the rash was lower than that in 2009 and the number of organs involved was reduced. The duration of fever, There was no significant change in the time of convalescence. The incidences of convulsions, brainstem encephalitis, pulmonary hemorrhage and stress ulcer also did not increase. There was no statistical difference in the auxiliary examinations including the abnormalities of blood glucose, white blood cells, CK-MB, ECG and X-ray Significance, early MRI examination positive rate; ventilator treatment parameters PIP and PEEP value, the average cure time in children and hospitalization days, the cure rate was not statistically significant. Conclusion The epidemiology, clinical features and treatment strategies of HFMD in critically ill patients in the recent 2 years have not changed significantly in our country. For HFMD critically ill children, preventive measures must be taken to reduce the mortality rate .