重症71型肠道病毒感染的临床特征与治疗12例分析

目的 探讨肠道病毒71型(enterovirus 71,EV71)感染所致重症病例的临床特征、病理生理变化,评估治疗效果.方法 对2008年湖北省9家定点医院收治的EV71感染重症手足口病(hand,foot and mouth disease,HFMD)病例的临床资料进行回顾性分析.结果 12例重症病例经RT-PCR检查EV71核酸阳性,其中男10例,女2例,中位数年龄1.96岁.发热持续时间6.5 d,皮疹持续时间7 d,起病至出现重症表现时间为3.7 d.神经系统受累10例,合并呼吸循环衰竭5例.5例X线胸片显示两肺或单侧片状阴影,4例为肺部纹理增多.白细胞计数、血糖、血沉和C-反应蛋白无特征性变化.11例选择大剂量静脉注射丙种球蛋白,7例使用甲泼尼龙治疗;4例肺水肿-呼吸衰竭患儿经呼吸机辅助通气,平均支持72(48～96)h.11例治愈,1例死亡.结论 EV71重症主要发生在年龄小于3岁患儿,以中枢神经系统感染为主,半数可发展为呼吸循环衰竭.早期使用呼吸机辅助呼吸对纠正呼吸循环衰竭,防止多脏器功能不全和降低死亡率尤为重要.

Clinical characteristics and treatment assessments of severe enterovirus 71 infected children

Objective To facilitate early recognition of ominous clinical manifestations,to understand pathophysiology and assess treatment effects in patients with severe entemvirus 71(EV71) associated hand,foot and mouth disease (HFMD).Method A retrospective analysis was performed based on the clinical records,laboratory data and treatment effects which were collected from twelve severe EV71 infected cases from nine hespitals in 2008,in Hubei province,China.Result Of the 12 severe cases,ten (83.3%)were male and two female.The median age was 1.96 yrs(8 m to 7 yrs).The mean hyperthermic duration was 6 days with the peak temperature over 38.5℃.and mean rash duration was 7 days.Fever and rash emerged simultaneously in 4 of 5 cases with cardiopulmonary failure.The severe complications included encephalitis(10 cases),pulmonary edema or hemorrhage(5 cases).Eleven cases were checked with magnetic resonance imaging(MRI)and four cases showed characteristics of encephalitis or meningitis,two with images of nasesinusitis and ethmoid-mastoid intlammation. Chest X-ray examination showed with pulmonary edema on single or both sides(5 cases),bronchitis(4 cages),and normal image(3 cases). There was no specific finding in the cardiac ultrasound and electrocardiogram in any of the patients,as well as the white blood cell count,blood glucose,prothrombin time,partial thromboplastin time and D-dimer.Cerebrospinal fluid showed aseptic meningitis with the increase of cell count in 7 cases.All patients were treated with antibiotics and/or antivirals,such as cephalosporins,ribavirin etc.Eleven patients were treated with intravenous immunoglobulin(total dose 2-4.5 g/ks)for 2-5 days,and the highest blood concentration of immunoglobulin was detected increasing at 7g/L. Seven cases were also treated with methylprednisolone 10-30 mg/(kg·d), four with dopamine,dobutamine,or digitalis.In addition,by using continuous positive airway pressure by nasal catheter and maintenance of circulation in the cases with cardiopulmonary failure could not relieve the symptoms of dyspnoea,and mechanical ventilation was required to maintain for a mean of 72 hrs (24-96 hrs).Except one case died ofpulmonary edema in the early stage,others were cured without sequelae.Conclusion Severe EV71 infection is more comHlon in children younger than 3 years old,in which the profound complications include encephalitis and pulmonary edema.The mechanical ventilation shouId be critically urged for child with complicating cardiopulmonary failure as soon.