手足口病2024例病因病机和分期辨证研究

目的通过对手足口病临床表现的回顾性研究,探讨手足口病分期辨证的模式。方法收集符合手足口病诊断的病例2024份,按照疹前期、岀疹期、恢复期整理分析其症状、体征,进行频数统计,分析手足口病各期的主要证候和兼杂证候,再进行证素聚类分析,总结出手足口病三期的主要病机、次要病机。结果疹前期以发热(70.30%)、口舌生疮(84.49%)、精神差(43.89%)、咳嗽(32.01%)、纳差(30.69%)为高发症状。岀疹期主要症状为发热(90.01%)、精神差或疲乏(51.08%)、口咽疼痛(72.77%)、纳差(80.78%)、皮疹(98.52%)和疱疹(88.48%),其次可出现肢体抖动(20.36%)、易惊(24.51%)、咳嗽(31.66%)、呕吐(9.54%)、大便干结(8.55%)。恢复期多数病例因为出院而统计不全,少数病例无明显不适。证素分析发现疹前期和岀疹期都以湿热(47.33%,43.84%)为主要证素,贯穿整个病程。其次风热(29.01%,25.70%)、正气亏虚(13.68%,7.51%)、气机逆乱(9.98%,14.93%)、内风(7.32%)在出疹期所占比例也较高。疹前期主要病机为温邪犯表,次要病机为正气亏虚;岀疹期主要病机为热毒内盛,肝脾失调,次要病机为正气亏耗。恢复期未做症状体征频数统计,证素分析病机特点为邪少正亏,气阴两虚。结论分期辨证更能体现手足口病的发生发展过程、临床表现的时空特点,可能更符合诊疗规范的制订。

Etiology and mechanism and syndromes differenation in periods on 2024 HFMD patients

Objective Exploring the patterns of syndrome differenation of HFMD on stage on the basis of the clinical study retrospectively.Methods Summering the major and the minor part of the mechanism of three periods of HFMD,by exploring the data of 2024 cases defined as HFMD,governing the clinical features,symptoms and the frequency of them in terms of the period of pre-pimples,pimples and afterwards,touching the main syndromes and the syndromes involved and clustering the analysis of the factors of the diseases.Results The pre-pimples period highlighted fever（70.30%）,boil in mouth and throat（84.49%）,fatigue（43.89%）,coughing（32.01%）,anorexia（30.69%）.The pimples focused on fever（90.01%）,fatigue（51.08%）,mouth and throat pain（72.77%）,anorexia（80.78%）,pimples（98.52%）and herps（88.48%）,followed by limb shaking（20.36%）,startle（24.51%）,coughing（31.66%）,vomiting（9.54%）,constipation（8.55%）.Most cases in the period of the afterwards were incomplete for leaving hospital.And few of them show obvious evidence for anything uncomfortable.syndrome factor analysis discovered that Shi-Re（47.33%,43.84%）was the main factor in the pre-pimples and the pimples,followed by Zheng-Qi difficency（13.68%,7.51%）,Qi in chaos（9.98%,13.93%）,Feng from the inside（7.32%）.The Wen Evil invading the surface of the body was the main body of the mechanism,the minor part was Zheng-Qi difficency.The mjor of the afterwards roled as burning fire inside and Gan-Pi system in dysfunction.,the minor one was the consumption of the Qi.As no frequency of the statistics involved in the afterwards,the mechanism assumed to be performed as Qi-Yin difficiency.Conclusion Syndrorne differentiation in stage was better than other TCM models to touch the complete process of HFMD and clinical feature in terms of time-space.Therefore,the agreement between Syndrorne Differentiation in Stage and the standard of the diagnosis and the treatment could be attached.