摘要
目的分析危重症手足口病的临床特点和机械通气治疗方法,提高救治水平。方法对2010年收治的34例危重手足口病(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回顾性分析。结果危重症病例以1～3岁男性患儿为主,均存在发热和皮疹,17例(50.0%)出现明显呕吐、易惊、肢体抖动、嗜睡,18例(52.9%)咯白色或粉红色泡沫痰,19例(55.9%)脑干脑炎,转为危重症时间平均3.27 d,X线胸片出现肺水肿征象25例(73.5%),27例行机械通气(SIMV模式),治愈17例,其吸气峰压(PIP)及呼气末正压(PEEP)均值分别为14.83 cmH2O和5.77 cmH2O,死亡比率为41.2%。结论伴有呕吐、易惊、肢体抖动、嗜睡及口腔分泌物多等都是危重症HFMD警示信号,应动态监测肺部X线影像,早期发现肺水肿,早期干预。HFMD发生脑干脑炎者病情凶险,死亡比率高。
Objective To analyze the clinical features of critical hand, foot and mouth disease and to summarize the effectiveness of mechanical ventilation in treatment of this disease, so as to raise the therapeutic capability. Methods The clinical data including general information, symptoms, signs, laboratory examinations, ventilator parameters and outcome of 34 children with critical HFMD treated in this hospital in 2010 were retrospectively analyzed. Results The majority of patients with critical HFMD were children with age of 1 to 3 years old, and all pa- tients had fever and rashes. Seventeen of them （50 % ） had vomiting, hyperarousal, limb trembling and lethargy. Eighteen （52 % ） cases had coughing with white or pink sputa and 19 （55.9%） emerged brainstem encephalitis. The duration for turning to critical condition on average was 3.27 days. X - ray examination showed edema of lung in 25 cases （73.5 % ）. Mechanical ventilation had been carried out in 27 cases, and their PIP and PEEP were 14.83 cmH2O and 5.77 cmH2O respectively. Among them, 17 were cured and the mortality rate was 41.2 %. Conclusion Vomiting, hyperarousal, limb trembling, lethargy and increased secretion of oral cavity are pre -warning signals of the disease. Dynamic monitoring of lungs with X - ray examination is very important in order to find the early pulmonary edema for early intervention. We should focus on discovery, isolation and mechanical ventilation as soon as possible.
出处
《临床和实验医学杂志》
2011年第17期1350-1351,1353,共3页
Journal of Clinical and Experimental Medicine
关键词
手足口
病危重症
临床特点
机械通气
Hand foot and mouth disease
Critical ill
Clinical characteristics
Mechanical ventilation
