EV71型重症手足口病并神经源性肺水肿存活与死亡患儿临床特点及治疗

发布时间：2018-05-13 00:39

  本文选题：手足口病 + 肠道病毒71　； 参考：《山东大学》2012年硕士论文

【摘要】：目的探讨EV71型重症手足口病(HFMD)并神经源性肺水肿(NPE)的临床特点、头颅MRI特征及死亡主要原因,提高重型HFMD患者治愈率和生存率。 方法收集我院2008-2011年确诊EV71型重症HFMD的56例患儿的临床资料,将其分为存活组及死亡组,两组患儿均行胸部X线检查,并进行血常规、生化、心肌酶及脑脊液检查,存活组在病情平稳的情况下均行颅脑MRI检查。对两组病例的性别比例、发病年龄、发病至机械通气的时间、入院至机械通气的时间、所出现的临床表现及实验室检查结果分别进行统计学整理分析。对两组病情动态变化、治疗及转归情况进行统计学比较分析。 结果与转归对两组病例的性别比例及发病年龄进行统计分析(P0.05),无明显统计学差异。两组患儿起病至机械通气时间比较(P0.05),无明显统计学差异；而入院至机械通气时间比较(P0.05),差异具有统计学意义。对两组患儿所出现的临床表现分别进行χ2检验,其中临床表现为眼球异常运动、昏迷、呼吸节律改变、咳粉红色泡沫痰、肺内湿Up音、心率≥200次/分、口周发绀、皮肤花纹的病例比较(P均0.05),表明两组病例的上述临床表现有统计学差异。对两组病例的外周血白细胞计数、血生化、心肌酶及脑脊液检查分别进行χ2检验,P值均0.05,表明两组病例的上述实验室检查结果无明显差异。两组患儿X线胸片检查均呈明显肺水肿表现,存活组患儿颅脑MRI检查均提示有脑干脑炎、脑软化灶改变。存活组患儿经机械通气30min～6h内肺部Up音明显减少或消失,机械通气时间21h～36d,成功脱机。死亡组患儿均于机械通气0.5～72h后死亡 结论NPE是临床急症,对出现神经系统损害的HFMD患者,应密切注意病情变化,及早发现NPE的早期症状和体征,分秒必争地进而进行有效的药物治疗,及时应用机械通气,才能减少死亡率
[Abstract]:Objective to investigate the clinical features, cranial MRI features and main causes of death of EV71 type severe HFMD with neurogenic pulmonary edema, and to improve the cure rate and survival rate of severe HFMD patients. Methods the clinical data of 56 children with EV71 type HFMD diagnosed in our hospital from 2008 to 2011 were collected and divided into survival group and death group. The patients in both groups underwent chest X-ray examination, blood routine examination, biochemical examination, myocardial enzyme examination and cerebrospinal fluid examination. In the survival group, craniocerebral MRI was performed under the condition of stable condition. The sex ratio, the age of onset, the time from onset to mechanical ventilation, the time from admission to mechanical ventilation, the clinical manifestations and the results of laboratory examination were analyzed statistically. The dynamic changes, treatment and outcome of the two groups were compared and analyzed statistically. Results the sex ratio and onset age of the two groups were statistically analyzed (P 0.05), and there was no significant difference between the two groups. There was no significant difference between the two groups in the time from onset to mechanical ventilation (P 0.05), but the time from admission to mechanical ventilation was significantly higher than that from admission to mechanical ventilation (P 0.05). The clinical manifestations of the two groups were tested by 蠂 2. The clinical manifestations were abnormal movement of eyeball, coma, change of respiratory rhythm, cough of pink foam phlegm, voice of up in lung dampness, heart rate 鈮，

本文编号：1880904