目標性救治措施在危重型手足口病并心肺

摘要：目的 分析目標性救治措施在危重型手足口病并心肺功能衰竭前期搶救中的運用價值。方法 對32例于2014年3月～2015年7月入住百色市兩家三甲醫院、三家二甲醫院重癥醫學科的重型手足口病伴心肺功能衰竭前期患兒，采用目標性救治為研究組；將2012年1～12月份未設定目標性救治的重型手足口病伴有心肺功能前衰竭的患兒22例為對照組，進行回顧性對比分析。結果 研究組存活21例（65.63%）與對照組比較6例（27.27%），差異有統計學意義（P<0.05）；治療后第7d，研究組體溫（37.14±0.58）、心率（120.46±12.42）、收縮壓（94.74±42.62）、血糖（6.85±1.45）、白細胞計數（10.23±3.30）均低于對照組（37.63±0.79，132.54±15.91，79.83±27.74，9.66±3.82，12.84±3.90），經比較差異有統計學意義（P<0.05），C反應蛋白經比較差異無統計學意義（P>0.05）。結論 目標性救治措施能提高危重型手足口病患兒的搶救成功率，挽救患兒的生命。

關鍵詞：目標性救治措施；手足口病；心肺功能衰竭前期；效果

Abstract：Objective To explore the practical value of targeted treatment measures toward the severe hand-foot-and-mouth disease combined with early cardio-pulmonary failure. Methods 32 cases of severe hand-foot-and-mouth disease combined with early cardio-pulmonary failure patients who were admitted into the two tertiary hospitals and the ICU of three secondary hospitals in Baise city during March 2014 and July 2015 was the experimental group， they were treated with targeted treatment measures； 22 cases of severe hand-foot-and-mouth disease combined with early cardio-pulmonary failure patients during January 2012 and December 2012 was the controlled group， they were not treated with targeted treatment measures； the curing results of the two group were analyzed with retrospectively contrastive analysis. Results The survival rate of experimental group （21 cases， 65.63%） was higher than the controlled group （6 cases， 27.27%）， the difference had statistical meaning （P<0.05）； after 7 days of treatment， the temperature （37.14±0.58），heart rate （120.46±12.42）， systolic pressure （94.74±42.62）， blood sugar （6.85±1.45） and white blood cell count （10.23±3.30） of the experimental group were all lower than the controlled group （37.63±0.79，132.54±15.91，79.83±27.74，9.66±3.82，12.84±3.90）， the differences had statistical meanings （P<0.05）， the difference of C-reactive protein did not have statistical meaning （P>0.05）. Conclusion Targeted treatment measure can increase the rescue success rate of severe hand-foot-and-mouth disease patients， rescuing children's life.

Key words：Targeted treatment measures；Hand-foot-and-mouth disease；Early cardio-pulmonary failure； Effect

手足口病（ hand-foot-mouth disease，HFMD）是兒童常見的急性傳染病，以3歲以下嬰幼兒發病率高；多由腸道病毒7l型（EV71） 感染引起；EV71 具有高度嗜神經性，腦干是最易感染的部位[1]。臨床上分為 4 期：手足口出疹期、神經系統受累期、心肺功能衰竭前期和心肺功能衰竭期，大多患兒預后良好，但少部分可發展為重癥、危重癥，甚至死亡[2]；心肺功能衰竭前期是HFMD重癥病例中的危重型。2014年百色市HFMD發病率在廣西甚至全國處于高位，重癥病例、死亡病例數多，成為廣西乃至全國重點防控地區[3]；衛生行政部門多次召開診治小組會議，統一部署臨床各期、特別是重癥病例的診治方案；運用目標性救治措施，分階段、分項目，設立搶救目標，兼顧救治每個環節，為臨床提供系統有效的救治方法。……