合并神经损害的危重型手足口病患儿临床特征及预后分析*
Analysis of clinical features and prognosis of children with severe hand？？food？？mouth disease combined with nerve damage

摘要目的：分析合并神经损害的危重型手足口病的临床特征及预后影响因素，为临床诊治和早期康复提供依据。方法：收集58例合并神经损害的危重型手足口病患儿的临床资料，进行汇总分析。对存活的42例患儿进行随访。结果：58例患儿中，脑干脑炎42例（72.4%）；急性弛缓性麻痹13例（22.4%），其中脑脊髓炎8例，类脊髓灰质炎综合征5例；脑炎3例（5.2%）。随访到的42例患儿中，康复30例，有后遗症12例（28.6%）；肺出血、腱反射减弱和肌力0级是影响神经预后的主要危险因素。结论：危重型手足口病患儿的神经系统损害以脑干脑炎和急性弛缓性麻痹为主，其后遗症的发生率高；合并肺出血、腱反射减弱和肌力0级的患儿预后差。
AbstractAim: To analyze the clinical features and prognosis of severe hand？？food？？mouth disease combined with nerve damage. Methods: The clinical data of 58 children with severe hand？？food？？mouth disease combined with nerve damage were collected. A total of 42 cases survived were followed up. Results: Out of the 58 cases, 42(72.4%) had brain stem encephalitis, 13(22.4%) had acute flaccid paralysis(8 cases of encephalomyelitis and 5 cases of class polio syndrome), and 3（5.2%） had encephalitis. Among the 42 patients that could be followed up, 12 (28.6%) presented with neurological sequelae; pulmonary hemorrhage, weak tendon reflexes and muscle strength of grade 0 were the major risk factors for neurological prognosis. Conclusion: Brainstem encephalitis and acute flaccid paralysis are the main manifestations of nerve damage in children with severe hand？？food？？mouth disease, resulting in a high incidence of neurological sequelae；the cases with pulmonary hemorrhage, weak tendon reflexes and muscle strength of grade 0 have poor outcome