覃艺　邓燕艺　赖昌生　甘宁　马晓红　李霞　丘丽莉

摘 要：目的 分析儿童重症手足口病的临床特点，以便于早期诊断。方法 回顾性分析玉林市红十字会医院2012年4月～2016年10月收治的554例重症HFMD患儿的临床资料。结果 554例重症HFMD患儿中3岁以下468例（84.48%），发烧432例（77.98%），平均峰值溫度为（38.20±0.93）℃，平均持续时间（2.06±1.26）d。552例（99.64%）患儿伴有不同数量皮疹或疱疹，休克40例（7.22%），神经系统受累511例（92.24%），神经系统受累平均时间为（2.46±1.24）d，主要表现有精神反应差（91.52%），双眼凝视（11.37%），易惊（90.97%），肢体抖动（67.32%），呕吐（6.86%），嗜睡（3.97%），烦躁（4.87%），昏迷（1.81%）等。白细胞升高421例（75.99%），血糖升高357例（64.44%），乳酸升高341例（61.55%）。EV71病毒阳性390例（70.40%），柯萨奇A16型阳性16 例（2.89%），肠道通用病毒阳性285例（52.44%）。29例（5.23%）死于神经源性肺水肿和呼吸衰竭，8例（1.44%）并发中枢性尿崩症，5例（0.90%）有残余神经系统后遗症。结论 高热，长期发热，精神不佳，易惊，四肢抖动，呕吐，嗜睡，烦躁，高白细胞，高血糖，高乳酸是重症手足口病的临床特征，特别伴有休克，双眼凝视，呼吸急促，持续性心率增快是早期鉴定重症病例的特征性表现，早期识别重症病例，及时干预，把治疗关口前移是降低死亡率和后遗症的关键。

关键词：手足口病；重症；临床特征；早期诊断

中图分类号：R725.1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.11.036

文章编号：1006-1959（2018）11-0115-03

Analysis of Clinical Features of Severe Hand Foot and Mouth Disease in 554 Children

QIN Yi，DENG Yan-yi，LAI Chang-sheng，GAN Ning，MA Xiao-hong，LI Xia，QIU Li-li

（Department of Pediatrics，Yulin Red Cross Hospital，Yulin 537000，Guangxi，China）

Abstract：Objective To analyze the clinical features of severe hand foot and mouth disease（HFMD）in children for early diagnosis. Methods The clinical data of 554 children with severe HFMD from April 2012 to October 2016 in Yulin Red Cross Hospital were retrospectively analyzed.Results Among 554 children with severe HFMD，468（84.48%）were younger than 3 years old and 432 （77.98%）were feverish.The average peak temperature was（38.20±0.93）°C and the average duration was（2.06±1.26）d.552 cases （99.64%）of children were associated with different numbers of rashes or herpes，40 cases（7.22%）of shock，511 cases（92.24%）of nervous system involvement，and the average time of nervous system involvement was（2.46±1.24）d，the main manifestations were poor mental response（91.52%），binocular gaze（11.37%），frightenedness（90.97%），limb jitter（67.32%），vomiting（6.86%），drowsiness（3.97%），irritability （4.87%），coma（1.81%）and so on.White blood cells increased in 421 cases（75.99%），blood glucose increased in 357 cases（64.44%），and lactic acid increased in 341 cases（61.55%）.EV71 virus was positive in 390 cases（70.40%），coxsackie A16 was positive in 16 cases （2.89%），and gut virus was common in 285 cases（52.44%）.29 cases（5.23%）died of neurogenic pulmonary edema and respiratory failure， 8 cases（1.44%）had central diabetes insipidus，and 5 cases（0.90%）had residual neurological sequelae.Conclusion High fever，long-term fever，poor spirit，easy to panic，limbs jittering，vomiting，drowsiness，irritability，high white blood cells，high blood sugar，high lactic acid are clinical features of severe hand foot and mouth disease，especially with shock，eyes staring，shortness of breath，persistent Increased heart rate is a characteristic feature of early identification of severe cases.Early identification of severe cases，timely intervention，and advancement of the treatment portal are the key to reducing mortality and sequelae.

Key words：Hand foot and mouth disease；Severe disease；Clinical features；Early diagnosis

手足口病（Hand foot and mouth disease，HFMD）是由腸道病毒引起的儿童常见急性传染病。我市为手足口病的高发区，每年4～6月份都出现集中暴发流行，其他月份也有散发流行，在学龄前儿童中感染很普遍，每年都有大量的重症病例出现。发病率以3岁以下儿童为最高。典型的临床表现为发热，手掌、脚底和口腔有皮疹和（或）疱疹。……