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【目的】分析山东省2009-2010年手足口病死亡病例的流行病学及临床特征,为降低手足口病病死率、优化重症病例治疗提供依据。【方法】对手足口病死亡病例进行个案调查和病原学检测,应用描述流行病学的方法分析患者的发病过程、流行病学特征和临床表现。【结果】手足口病死亡病例的平均年龄为1.5岁,2岁以下病例占83.0%;农村多于城市,男性多于女性,男女病例性别比为3.4∶1。死亡病例以EV71感染为主,占86.7%,总病程为(82.4±4.7)h。96.9%的死亡病例以发热起病,皮疹平均在发热后1.06d出现,主要的临床表现还包括易惊、烦躁不安、嗜睡、手足抖动、气急、呼吸困难、呼吸节律改变、口吐粉红色泡沫痰、肺部湿罗音、心跳节律改变、呕吐等;患者死亡的主要原因为神经源性肺水肿(96.9%)、脑炎(65.6%)和呼吸循环衰竭(46.9%)。【结论】≤2岁手足口病死亡病例病程短、病死率高。加强监护,提高对手足口病重症表现的早期识别能力和敏感性,尽早干预治疗,延缓重症进程,对减少手足口病死亡至关重要。
【Objective】 To analyze the epidemiological and clinical features of hand-foot-mouth disease in Shandong province from 2009 to 2010, and provide the basis for reducing the mortality of hand-foot-mouth disease and optimizing the treatment of severe cases. 【Methods】 Case-by-case and etiological tests were conducted on deaths of hand-foot-mouth disease. Epidemiological methods were used to analyze the course of disease, epidemiological characteristics and clinical manifestations. 【Results】 The average age of death from hand-foot-mouth disease was 1.5 years and 83.0% of cases were below 2 years old. There were more rural than urban women and more men than women. The sex ratio of male to female was 3.4:1. The deaths were mainly EV71 infection, accounting for 86.7% of the total. The total duration of disease was (82.4 ± 4.7) h. 96.9% of the deaths occurred with fever onset. The rashes appeared on average 1.06 days after fever. The main clinical manifestations included: easy to be scared, irritable, drowsiness, hand-foot jitter, shortness of breath, dyspnea, Sputum, wet rales in the lungs, changes in heart rhythms and vomiting. The main causes of death were neurogenic pulmonary edema (96.9%), encephalitis (65.6%) and respiratory failure (46.9%). 【Conclusions】 The deaths of hand-foot-mouth disease ≤2 years old have short course and high mortality. To strengthen guardianship and improve the early recognition ability and sensitivity of severe manifestations of hand foot and mouth disease, intervention in treatment as soon as possible and to delay the serious course are crucial for reducing the death of hand foot and mouth disease.