摘要
目的探讨儿童重症手足口病合并中枢神经系统感染及神经源性肺水肿（NPE）的临床特征、救治经验和转归。方法总结2008年5月至6月收入安徽省阜阳市级医院儿童重症监护病房（PICU）手足口病合并中枢神经系统感染及NPE救治资料。结果36例患儿中，平均年龄15．8个月（4月至4岁），死亡7例，病死率为19．4％。出现危重症状平均病程2．1d（0．5～5．0d）。12例（33．3％）无皮疹。神经系统表现为脑干脑炎27例（75％）、脑干脑炎伴脊髓炎6例（16．7％）、脑炎3例（8．3％）。NPE突出表现是突然呼吸急促、粉红色或血性泡沫液（痰）、非对称性肺水肿或肺出血，是最直接死亡原因。主要救治措施为机械通气、甘露醇、甲基强的松龙、静脉丙种球蛋白、血管活性药物，其中9例患儿（25％）进行容量复苏。结论EV71脑炎合并NPE，发病年龄小，进展快，病死率较高。早期诊断、及时呼吸支持、积极降颅压、维护循环功能是救治成功的关键。
Objective To investigate the chnical characteristics and emergency management of severe hand- foot-mouth disease（HFMD） associated with encephalitis and neurogenic pulmonary edema （NPE） caused by enterovirus 71（EV71） in children. Method Data of critical patients with severe HFMD associated with encephalitis and NPE admitted to pediatric intensive care unit （PICU） Fuyan city Hospitals Anhui Province from May to June 2008 were reviewed. Results Of 30 patients, the mean age was 15.8 months ranged from 4 months to 48 months. The overall mortality was 19.4% .Tha average duration of critical symptoms persisted was 2.1 days ranged from 12 hours to 5 days. There were no rash found in 12 patients （33.3 % ）. The chinical features of nervous system mani- fested the symptoms of brainstem encephalitis in 27 patients （75%）, brainstem encephalitis with myelitis in 6 patients （16.7%）, and encephalitis in 3 patients （8.3%）. The frothy expectoration tinged with pink or bloody, asymmetrical pulmonary edema or hemoptysis were the main features of NPE. The main approaches to the treatment were mechanical ventilation, mannitol, methylprednisolone, intravenous immunoglobulin（IVIG）, and vasoactive agents. And nine patients （25 % ） needed fluid volume resuscitation in addition. Conclusions Young children are particularly vulnerable to the severe EV71 encephalitis with NPE. The majority of involved fatal patients are aged under 3 years. Patients may die of acute onset of NPE and/or hemoptysis with rapid progress towards cardiopulmonary failure. Early diagnosis and evaluation, respiratory support, lowering intracranial pressure and maintaining hemodynamics are the essential therapeutic approaches.
出处
《中华急诊医学杂志》
CAS
CSCD
2008年第12期1250-1254,共5页
Chinese Journal of Emergency Medicine
