死亡危重型手足口病临床特点分析 Clinical Characteristics Analysis of Dead Critical Type of Hand-Foot and Mouth Disease Children

目的：探讨进入IV期危重型手足口病(Hand-mouth and foot disease, HFMD)死亡的临床特点、诊治经过及死亡分析，总结经验及教训。方法：采用回顾性分析方法对2009年1月至2014年12月昆明周边及地州转入我院救治19例危重型HFMD患儿的临床资料进行分析。结果：19例患儿来自农村，其中男性13例(68.42%)，女性6例(31.58%)，3岁以下16例，占84.21%，3岁以上3例，占15.79%。所有病例均有发热、惊跳、肢体抖动的表现。16例患儿入院时出现肺出血、呼吸循环衰竭的表现。17例患儿均出现白细胞总数及中性粒细胞、超敏C-反应蛋白升高，12例血糖升高。4例合并消化道出血，1例同时合并肾功能衰竭。病原学：18例EV71阳性，1例为其它未定型肠道病毒感染。结论：早期识别并及时治疗第2期HFMD病例，及时进行干预，避免进展为危重型HFMD，危重型HFMD主要由EV71病毒感染引起，致死率高，进入IV期危重型HFMD出现神经源性肺水肿、肺出血、呼吸循环衰竭、严重脑功能障碍等严重并发症，死亡率高。 Objective: To investigate clinical characteristics into the type of hand, foot and mouth disease in acute stage IV, and diagnosis and treatment of the death cases, summarizes the experiences and lessons. Methods: Retrospective analysis was used to study the 19 cases clinical data of critical HFMD in the area around Kunming from January 2009 to December 2014. Results: 19 cases were from countryside, 13 of which were boys (68.42%), 6 of were girls (31.58%), 16 under 3 years (84.21%) and 3 above 3 years of age (15.79%). All cases had fever, startle and limb jitter. Pulmonary hemorrhage and respiratory failure occurred in 16 cases. 17 cases of children pre-sented increased white cell count, neutrophilic granulocytes and hypersensitivity C-reactive protein, and 12 cases blood sugar were elevated. 4 cases were complicated with alimentary tract hemorrhage and 1 case was combined with Kidney function failure. Pathogeny: 18 cases of EV71 were positive，and another one is the other enterovirus infection. Conclusion: It was very critical to early identify and treat stage II HFMD to avoid the progression to severe HFMD which was mainly caused by EV71 virus. The stage IV HFMD appeared serious complication: Neurogenic pulmonary edema, pulmonary hemorrhage, respiratory failure, brain dysfunction, and so on. The fatality rate was very high.