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重症肠道病毒71型感染并发肺出血28例抢救成功原因分析

王宏杰   

  1. 天津市儿童医院感染科
  • 收稿日期:2013-04-11 修回日期:2013-07-15 出版日期:2013-11-15 发布日期:2013-11-15
  • 通讯作者: 王宏杰

The analysis of the reasons why 28 critical hand,foot and mouth disease infected by EV71 with pulmonary hemorrhage were cured successefully

  • Received:2013-04-11 Revised:2013-07-15 Published:2013-11-15 Online:2013-11-15

摘要: 【摘要】目的 探讨肠道病毒71型感染导致手足口病并发肺出血患儿的抢救成功原因,寻找影响危重症手足口病临床预后的因素。方法 采用回顾性方法对28例抢救成功重症EV71合并肺出血患儿的治疗进行总结分析,均予呼吸机正压通气,依据床旁心电图及UCG,对于心脏功能无明显异常的患儿予多巴胺、米力农改善循环,对于心脏功能明显异常的患儿予多巴胺、硝普钠改善循环,限制入量,合理使用脱水剂,保护神经细胞,糖皮质激素、人免疫球蛋白治疗,合理使用抗菌药物等治疗。结果 28例患儿均抢救成功,住院16-30天出院,22例近期未留下后遗症,2例左上肢肌力下降,2例双下肢肌力下降,2例左下肢肌力下降伴肌张力增高。结论 手足口病危重症起病急,病情进展迅速,及时、正确的机械通气,合理的血管活性药物应用以及综合治疗是提高危重症手足口病抢救成功率的关键,中枢神经系统的受累部位可能是影响患儿病情预后的最重要因素之一。

关键词: 手足口病, 危重症, 肺出血, 肠道病毒A型, 人, 急救

Abstract: Abstract: Objective To explore the reasons why critical hand,foot and mouth disease with pulmonary hemorrhage were cured successefully which was infected by Enterovirus 71,looking for the factors which influcing the prognosis of critical hand,foot and mouth disease. Methods A retrospective analysis of 28 critical hand,foot and mouth disease with pulmonary hemorrhage who were cured successefully was completed,which was about the treatment methods. Positive pressure ventilation had been used in all patients. According to the bedside EKG and UCG,dopamine and milrinone were used to improve circulation to those whose cardiac function weren’t obviously abnormal,dopamine and sodium nitroprussiate were used to improve circulation to those whose cardiac function were obviously abnormal,restriction of fluid volume,proper use of dehydrant,protection of cerebral cells,intravenous impulsion injection of glucocorticoid and γ-immunoglobulin,reasonable application of antibiotics,et al. Results 28 children were cured successfully,the days of hospitalization was 16-30,22 children had’t have any sequela in the near future,2children had the left upper limb with dropped muscle strength,2 children had the pair of lower limbs with dropped muscle strength,2 children had the left leg with dropped muscle strength and increased muscle tension. Conclusions The characteristic of critical hand,foot and mouth disease was acute onset,rapid progress. They were cured successfully because of the mechanical ventilation in first time,the reasonable used vasoactive drugs and comprehensive treatment. The damaged region of central nervous system is one of the most important factors which influencing the prognosis of hand,foot and mouth disease.