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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2016, Vol. 10 ›› Issue (04) : 459 -462. doi: 10.3877/cma.j.issn.1674-1358.2016.04.016

临床论著

896例小儿手足口病的临床观察与护理对策
高冬梅1, 吴凤1, 胡婷婷1, 江碧芹1, 洪树芹1,†()   
  1. 1. 223001　淮安市，淮安市第四人民医院
  • 收稿日期:2015-07-15 出版日期:2016-08-15
  • 通信作者: 洪树芹

Clinical observation and countermeasure of 896 children with hand, foot and mouth disease

Dongmei Gao1, Feng Wu1, Tingting Hu1, Biqin Jiang1, Shuqin Hong1,†()   

  1. 1. The Fourth People’s Hospital of Huaian, Huaian 223001, China
  • Received:2015-07-15 Published:2016-08-15
  • Corresponding author: Shuqin Hong
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高冬梅, 吴凤, 胡婷婷, 江碧芹, 洪树芹. 896例小儿手足口病的临床观察与护理对策[J]. 中华实验和临床感染病杂志(电子版), 2016, 10(04): 459-462.

Dongmei Gao, Feng Wu, Tingting Hu, Biqin Jiang, Shuqin Hong. Clinical observation and countermeasure of 896 children with hand, foot and mouth disease[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2016, 10(04): 459-462.

目的

探讨手足口病患儿的临床表现以及相应的护理对策，为治疗手足口病提供临床依据。

方法

回顾性分析本科收治的896例手足口病患儿的临床资料。

结果

895例手足口病患儿经过临床诊疗和细心的护理，均基本恢复或有所好转，仅有1例手足口病患儿转到外院治疗后死亡；手足口病患儿多发病于5岁以下，男性多于女性；1～2岁的手足口病患儿较多，占41.74%，其次是< 1岁的患儿发病较多。手足口病患儿皮疹主要分布于手掌、足掌、口腔黏膜，构成比例分别为64.21%、57.12%和63.54%。896例手足口病患儿全部有皮疹，691例（占77.10%）患儿伴有发热症状，其中热峰> 39 ℃的患儿263例，构成比占29.40%。手足口病患儿白细胞计数升高（605例，占67.50%），其余也表现出白细胞正常或降低。人柯萨奇病毒A16和人肠道病毒71型感染占主要部分，分别为444例（占49.60%）和340例（占37.90%），其他肠道病毒感染126例（占14.10%），合并病毒感染中流感病毒感染所占比例较高达到51.20%。

结论

手足口病患儿发病年龄小，病情进展迅速，早期临床表现较隐匿，如能早期发现，及时干预治疗及精心的护理，则预后良好。

关键词: 手足口病, 儿童, 护理对策
Objective

To investigate the clinical manifestations of children with hand, foot and mouth disease (HFMD) and the corresponding nursing strategies, and to provide the clinical basis for treatment of children with HFMD.

Methods

The data of 896 children with HFMD in our department were analyzed, retrospectively.

Results

Total of 895 cases with HFMD after clinical treatment and careful nursing, all were recovered or improved, except only 1 case was dead after treatment in other hospital. Children with HFMD were mainly under the age of 5 years old, more male than female; mainly 1 to 2 years old children with HFMD (41.74%), followed by under the age of 1 year old. Rash of children with HFMD mainly distributed in the palm of the hand, foot and mouth mucosa, the proportion were 64.21%, 57.12% and 63.54%, respectively. All the 896 cases with HFMD had a skin rash, 691 cases (77.10%) were accompanied by fever. There were 263 cases with the heat peak higher than 39 ℃, accounting for 29.40%. There were 605 cases (67.50%) with increased white blood cell (WBC) count, the rest showed normal or decreased WBC. Patients with Coxsackie virus A16 (CoxA16) and enterovirus 71 (EV71) infection accounted for the major part, 444 cases (49.60%) and 34 cases (37.9%), respectively; the other 126 cases (14.10%) were infected with other enterovirus. Influenza virus infection among the complicated virus infection in the patients accounted for a higher proportion up to 51.2%.

Conclusions

The children with HFMD were young, the disease progresses rapidly, and the early clinical manifestations were occult, but with early detection, timely intervention and careful nursing, the prognosis would be good.

Key words: Hand, foot and mouth disease (HFMD), Child, Nursing strategy
表1 896例HFMD患儿性别和年龄分布
一般资料 病例数 构成比（%）
性别    
  男 473 52.79
  女 423 47.21
年龄（岁）    
  < 1 208 23.21
  1～2 374 41.74
  2～3 187 20.87
  4～5 101 11.27
  > 5 26 2.90
表2 896例HFMD患儿皮疹部位分布
部位 例数 构成比（%）
手掌 575 64.21
足掌 512 57.12
肛周 239 26.64
臀部 204 22.73
下肢膝盖 164 18.32
口腔黏膜 569 63.54
表3 896例HFMD患儿的临床表现
临床表现 例数 构成比（%）
皮疹 896 100.00
发热 691 77.10
呕吐 192 21.40
易惊 83 9.30
抽搐 2 0.25
头痛 7 0.79
咳嗽 192 21.40
嗜睡 16 1.80
休克 11 1.20
食纳差 133 14.80
精神差 86 9.60
呼吸困难 9 0.96
肺部啰音 65 7.20
饮水呛咳 6 0.69
热峰> 39 ℃ 263 29.40
心率> 100次/min 603 67.30
表4 896例HFMD患儿的辅助检查
辅助检查 例数 构成比（%）
血糖升高 462 51.60
胸片异常 212 23.70
脑CT异常 53 5.90
转氨酶升高 71 7.90
体液免疫异常 122 13.60
心肌酶谱升高 194 21.60
降钙素原升高 194 21.70
白细胞正常 282 31.50
白细胞降低 39 4.30
白细胞计数升高 605 67.50
白细胞> 15 × 1012/L 65 7.30
T淋巴细胞转化率偏低 101 11.30
表5 896例HFMD患儿的病原学特点
观察指标 例数 构成比（%）
EV71 340 37.90
CoxA16 444 49.60
支原体感染 55 6.10
衣原体感染 33 3.70
合并腺病毒感染 144 16.10
合并EB病毒感染 80 8.90
合并流感病毒感染 459 51.20
其他肠道病毒感染 126 14.10
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