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目的探讨手足口病(HFMD)并心肌损伤患儿的临床特征及预后。方法选择2010年4-6月在湖南省儿童医院ICU住院治疗的HFMD重症及危重症患儿为研究对象,了解HFMD患儿心肌损伤的发生率,对其临床特征和辅助检查结果进行总结分析,比较心肌酶学异常组和心肌酶学正常组神经、呼吸和循环系统表现,以及辅助检查结果的差异,明确HFMD并心肌损伤患儿的预后。结果共369例患儿纳入分析,血清CK-MB和(或)心肌肌钙蛋白I(cTnI)升高者247例(66.9%)。心肌酶学异常组(包括cTnI升高组、CK-MB升高组及cTnI、CK-MB均升高组)平均热程,抽搐、肢体瘫痪、意识改变和脑神经受累的发生率,心率增快或减慢、血压异常、毛细血管充盈时间(CRT)>3 s、心力衰竭、呼吸节律改变的发生率及血管活性药物的使用率,CRP及血乳酸升高发生率均显著高于心肌酶学正常组。心肌酶学异常组危重症、神经源性肺水肿和肺出血的发生率及病死率均显著高于心肌酶学正常组。结论 HFMD患儿心肌损伤的发生率高,心肌酶谱、cTnI、CRP及血清乳酸水平的升高提示心肌损伤的发生;心肌酶学异常的HFMD患儿更易出现中枢神经系统受累的表现,病情更严重,预后更差。
Objective To investigate the clinical features and prognosis of children with hand-foot-mouth disease (HFMD) and myocardial injury. Methods From April to June 2010, children with HFMD and critically ill children hospitalized in ICU of Hunan Children’s Hospital were enrolled in this study. The incidence of myocardial injury in children with HFMD was analyzed. The clinical features and auxiliary examinations were analyzed. The differences in the neurological, respiratory and circulatory system and the results of the auxiliary examinations were compared between the group of abnormal myocardial enzymes and the group of normal cardiac enzymes, and the prognosis of children with HFMD and myocardial injury was compared. Results A total of 369 children were included in the analysis, and 247 patients (66.9%) had elevated serum CK-MB and / or cardiac troponin I (cTnI). Myocardial enzymes abnormalities group (including elevated cTnI group, CK-MB elevated group and cTnI, CK-MB were elevated group average heat stroke, convulsions, limb paralysis, changes in consciousness and the incidence of cranial nerve involvement, increased heart rate Fasting or slowing, abnormal blood pressure, capillary filling time (CRT)> 3 s, the incidence of heart failure, respiratory rhythm changes and the use of vasoactive drugs, the incidence of CRP and blood lactate were significantly higher than that of myocardial enzymes Learn normal group. Serum enzyme abnormalities group critically ill, neurogenic pulmonary edema and pulmonary hemorrhage incidence and mortality were significantly higher than normal myocardial enzyme group. Conclusions The incidence of myocardial injury in children with HFMD is high. The increase of myocardial enzyme spectrum, cTnI, CRP and serum lactate level indicate the occurrence of myocardial injury. The HFMD patients with HFMD are more likely to have central nervous system involvement. Serious, worse prognosis.