重症手足口病的甄别及救治.ppt

重症手足口病的甄别及救治 特别声明 本课件含大量视频图像及相片，涉及病人肖像权法律问题，课件仅作教学用途，不予复制，敬请原谅。 手足口病危重症 究竟有多危重？ 例： 6?月?5?日入院 ? 17:20:14 ?17:33:14 病情急剧变化 既往的“经验”可靠吗？ 背景资料 typically a benign and common illness among children and infants characterized by rapidly ulcerating vesicles in the mouth and lesions, usually vesicular, on the hands and feet. become an important public health disease due to its tendency to cause large outbreaks and deaths among children and infants. Hand foot and mouth disease may be related to coxsackieviruses A16, A5, A9, A10, B2, B5 and enterovirus 71. caused by enterovirus 71 (EV71) can be more severe and may be complicated with meningitis, encephalitis and neurogenic pulmonary edema. 背景资料From:N Engl J Med 1999;341:929-35. In Taiwan, based on 1998 epidemic, the sentinel physicians reported 129,106 cases of hand-foot-and-mouth disease or herpangina in two waves of the epidemic, which probably represents less than 10 percent of the estimated total number of cases. There were 405 patients with severe disease, most of whom were five years old or younger. Seventy-eight patients died （19.2％）, 71 of whom (91 percent) were five years of age or younger. Of the patients who died, 65 (83 percent) had pulmonary edema or pulmonary hemorrhage. Complications included encephalitis, aseptic meningitis, pulmonary edema or hemorrhage, acute flaccid paralysis, and myocarditis. 背景资料 中国小儿急救医学 2008；15：217-220 近年全国多个地区爆发疫情，导致部分婴儿死亡和致残。回顾性分析重症、危重症病例，早期特点如下： 年龄3岁（95%以上）死亡病例平均年龄1.5岁左右 可无皮疹或皮疹不典型 末梢循环不良 CRT3s，口周发绀而SpO295%。躯干四肢冰冷和皮肤发花范围越广、程度越深，其预后越差 意识障碍严重或快速加重 GSC：3-8分 外周血WBC可达20.0x109/L,中性比例0.6-0.7以上，强烈应激成熟池释放 血糖明显增高 呼吸急速、困难，节律不整 持续高热 心率明显加快，血压增高 神经源性肺水肿(neurogenic pulmonary edema，NPE) 在无原发性心、肺和肾等疾病的情况下，由颅脑损伤或中枢神经系统(central nervous system，CNS)其他疾病引起的突发性颅内压增高而导致的急性肺水肿 手足口病是CNS感染引起小儿NPE最常见的原因 ，起病急，治疗困难，病死率高(60％～100％) 冲击伤(blast theory)和渗透缺陷理论(permeability defect theory) 两种损伤共同作用的结果 ---From: 郭红梅.肠道病毒71神经系统感染.[J] .国外医学.流行病学传染病学分册, 2002,29(1):19-21. 冲击伤