摘要
目的提高肠道病毒71型(EV71)感染重症死亡病例预警症状和体征早期甄别能力。方法复习文献穷尽EV71感染重症病例临床表现,临床诊断EV71感染重症病例时开始观察,死亡病例进入本文分析,以首次发热作为EV71感染起病零时点,系统记录症状和体征出现的时间,统计死亡前(特别是6、12、和24 h)的临床症状和体征并进行神经系统定位。结果 2010年1月1日至2012年12月31日5家参与医院住院并系统观察记录了54例EV71感染重症死亡病例,男31例,女23例,5岁以下53例,发病至死亡时间中位数78.5(6~432)h,120 h内死亡43例(79.6%),4项一般指标均被记录(发热、皮疹、咽峡炎和流感样症状),余89项观察指标中7项未被记录到。除一般指标外,起病至36 h出现的症状体征有8项:特异性指标(1项)、运动障碍指标(6项)和植物神经功能紊乱指标(1项);~48 h症状体征增加了25项:运动障碍指标(16项)、意识障碍指标(1项)和植物神经功能紊乱指标(8项);~60 h症状体征增加了15项:运动障碍指标(11项)、意识障碍指标(1项)和植物神经功能紊乱指标(3项)。出现超高热、顽固休克、深昏迷、超高心率和持续超高血压者,神经系统定位主要在延髓和部分下丘脑,6 h内死亡;出现眼球共济失调、呼吸共济失调、咽反射减弱/消失、肺渗出、呼吸节律异常和血压升高者,神经系统定位于交感神经、中脑与延髓,12 h内死亡;出现焦虑不安、疲倦思睡、肢体抖动、惊跳、呕吐、皮疹、发热者,距离死亡超过24 h。结论 EV71感染死亡病例临床表现具神经系统定位意义,及时甄别死亡前预警症状体征对降低EV71感染病死率有重要意义。
Objective Analyzing the symptoms and signs to improve capability of discerning critical condition in EV71 infection commitment. Methods Massive literatures of clinical manifestations of severe cases of EV71 infection were reviewed,then the occurtime of symptoms and signs was recorded in hours from onset-symptoms,as fever,when clinical diagnosis of severe cases of EV71 infection was made. The first onset-time of symptoms and signs was recorded in severe EV71 infection cases,and at 6,12 and 24 before death,respectively. The clinical symptoms and signs were recorded and their neural localization was analyzed. Results A total of 54 death cases( 31 males and 23 females) from 5 participating hospitals from January 1,2010 to December 31,2012 were observed. 53 cases were 5 years old. The median time from disease onset to death was 78. 5( 6- 432) h,43 of which( 79. 6%)died within 120 h. Four general indicators were recorded( fever,rash,herpangina and flu-like symptoms),more than 89 indicators were recorded except seven unobserved. In addition to general indicators,8 symptoms and signs were observed within 36 h,mainly as the specific indicators( 1 item),movement disorders indicators( 6 items) and autonomic dysfunction index( 1 item); 25 signs and symptoms increased in 36- 48 h,including movement disorders index( 16 items),unconsciousness index( 1 item) and autonomic dysfunction index( 8 items). 15 signs and symptoms appeared in 49- 60 h,including movement disorders index( 11items),unconsciousness index( 1 item) and autonomic dysfunction index( 3 items). Ultrahyperpyrexia,persistent shock,deep coma,excessive tachycardia and sustained ultra-hypertension,neuropathic positioned mainly in the medulla and part of the hypothalamus appeared at 6 h before death,eyeball ataxia,respiratory ataxia,pharyngeal reflex decreased / disappear,NPE,respiratory rhythm abnormalities and hypertension,located in the sympathetic nervous system,the brain and the medulla appeared in 12 h before death,and anxious,tired somnolence,limb shaking,startle
出处
《中国循证儿科杂志》
CSCD
2014年第5期338-344,共7页
Chinese Journal of Evidence Based Pediatrics
关键词
肠道病毒71型
症状体征
病程
定位
儿童
Enterovirus 71
Symptoms / Signs
Course
Localization
Pediatrics
