EV71手足口病合并脑炎早期临床特点和治疗.docVIP

EV71手足口病合并脑炎早期临床特点和治疗 　　【中图分类号】R373.3 【文献标识码】B 【文章编号】1672－3783(2012)03－0092－01 　　 【摘要】目的 探讨EV71所致手足口病患儿合并脑炎的早期临床特点、救治经验和转归，为EV71所致手足口病脑炎的早期诊断、早期治疗提供依据。方法 对2010年7月至2011年7月90例入住本院感染科确诊为EV71所致手足口病合并脑炎的患儿的发病年龄，季节，临床表现，治疗方案及临床转归进行分析。结果 EV71手足口病发病季节主要集中在5-7月份，合并脑炎重症病例早期予脱水，糖皮质激素，免疫球蛋白，免疫调节剂和中成药治疗，无一例死亡。结论 EV71手足口病合并脑炎患儿病情进展迅速，早期表现隐匿，早期发现并治疗预后良好。积极降颅压、大剂量静脉丙种球蛋白和短期激素治疗是阻止重症向危重症转变的有效手段。 　　【关键词】EV71；手足口病；脑炎；临床特点；治疗 　　【Abstract】Objectives: To discuss the pristine clinical characteristics，the experience of the treatment and the termination of hand foot and mouth disease (HFMD) complicated with encephalitis due to enterovirus-71 in Suzhou, China. And to provide scientific evidence for early diagnosis and treatment with HFMD complicated with encephalitis. Meathods: The patients addmitted to our hospital with the diagnosed of HFMD were enrolled during July 2010 to July 2011. 90 patients with encephalitis were involved to analyse the differentiation of the age, season, clinical menifestation, treatment, and the termination. Results: The epidemic season of enterovirus-71 focus on May to July. It was effective to give early dehydration，glucocorticoid，immunoglobulin, immunomodulator and chinese traditional medicine. There was nobody died. Conclusions: It was progressed quickly in HFMD with encephalitis. The clinical menifestation of early phase was obsolete. Treating severe EV71 encephalitis patients with prompt dehydration, intravenous IgG and short term glucocorticoid is associated with significantly decreased mortality by attenuated sympathetic activity and cytokine production. 　　【Key words】enterovirus-71, hand foot and mouth disease, encephalitis, clinical characteristics, treatment 　　 手足口病是由肠道病毒引起的急性传染病，以婴幼儿发病为主，重症病例多由EV71感染引起??［1］?。我院承担了苏州地区手足口病，特别是重症手足口病的主要诊治工作，现将我院感染科2010年7月至2011年7月收治的EV71手足口病合并脑炎90例病例的临床资料分析如下。 　　1 资料与方法 　　1.1 一般资料 　　 90例患儿的诊断均符合2010版手足口病诊疗指南??［1］?，手、足、口、臀部皮疹伴或不伴发热，血清检测EV71阳性，腰椎穿刺确诊脑炎。 　　1.2 EV71手足口病合并脑炎年龄分布：0-1岁，4例，占4.4%；1-2岁，26例，占28.8%；2-3岁，14例，