摘要：

目的 总结重症手足口病合并神经源性肺水肿的临床特点和有效治疗方法。方法 回顾分析11 例重症手足口病合并神经源性肺水肿患儿的诊断与治疗经过，包括临床表现、实验室、影像学和神经电生理学检查。结果 11 例患儿均有手足口病接触史，临床表现为发热伴皮疹、易惊、肺水肿；4 例入院时Glasgow 昏迷量表评分≤ 7 分；5 例头部MRI 显示脑桥和延髓长T₁、长T₂ 信号影，2 例脑桥长T₂ 信号影，1 例延髓长T₁、长T₂ 信号影；9 例超声心动图射血分数≥ 41.50%。均予气管插管呼吸机辅助通气、降低颅内压、合理应用血管活性药物、激素、静脉注射免疫球蛋白并辅以营养神经和心肌等对症支持治疗，合并呼吸机相关肺炎者联合应用抗生素。3 例（3/11）完全康复，5 例（5/11）转入康复科继续康复治疗，3 例（3/11）死亡。结论 重症手足口病合并神经源性肺水肿起病急骤，发展迅速，病死率较高。予气管插管呼吸机辅助通气、降低颅内压、合理应用血管活性药物、激素和静脉注射免疫球蛋白可以改善预后，治疗成功的关键在于积极气管插管呼吸机辅助通气，正确处理神经源性循环功能障碍。

关键词: 手足口病, 肺水肿, 肠道病毒感染, 超声心动描记术

Abstract:

Objective  To analyze clinical presentations of children's neurogenic pulmonary edema due to severe hand-foot-mouth disease (HFMD), and inquire the effective treatment.  Methods  The clinical data of 11 children diagnosed as neurogenic pulmonary edema associated with severe HFMD in our hospital were retrospectively analyzed. The clinical manifestation, laboratory examination, imaging and neuropsychological examination were analyzed.  Results  All patients were younger than 5 years, and all contacted with severe HFMD. They presented with fever, skin rash, irritability and pulmonary edema. Glasgow Coma Scale (GCS) score of 4 cases was ≤ 7 on admission; head MRI of 5 cases showed long T₁ and T₂ signals in pons and medulla, 2 cases showed long T₂ signal in pons, and one case showed long T₁ and T₂ signals in medulla; echocardiography ejection fraction (EF) of 9 cases was ≥ 41.50%. Patients were treated by tracheal intubation assisted ventilation, decreasing intracranial pressure, rational vasoactive agents, corticosteroids, intravenous immunoglobulin (IVIg) assisted by nerve cells nutrition and myocardial support. Antibiotic therapy was used when combined with breathing machine related pneumonia. After treatment, 3 cases (3/11) died, 3 cases (3/11) were cured and 5 cases (5/11) had paralysis sequelae and referred to rehabilitation. Conclusions  Neurogenic pulmonary edema combined with severe HFMD has acute onset, rapid proceeding and high mortality. Tracheal intubation assisted ventilation, decreasing intracranial pressure, rational vasoactive agents, corticosteroids and IVIg can improve the prognosis. The key points of treatment are early tracheal intubation assisted ventilation and proper treating of neurogenic circulation dysfunction.

Key words: Hand, foot and mouth disease, Pulmonary edema, Enterovirus infections, Echocardiography