The Clinical Characteristics And Treatment Of Severe EV71Type Hand Foot And Mouth Disease Combined With Neurogenic Pulmonary Edema In Survival And Death Patients

Objective To investigate the clinical manifestation, characteristics of head magnetic resonance imaging (MRI) and the main death cause of severe EV71type hand foot and mouth disease (HFMD) combined with neurogenic pulmonary edema (NPE) in order to increase the cure rate and survival rate of severe HFMD.Methods56pediatric patients, diagnosed as severe EV71type HFMD during2008and2011in our hospital, were classified into survival group and death group. Chest X-ray, routine blood test, blood biochemistry, serum myocardial enzymes and cerebral spinal fluid were detected. Cranial magnetic resonance image (MRI) detection was performed in patients of survival group during the convalescence stage. Statistic analysis was applied in gender, age, the time from the beginning to mechanical ventilation and from admission to mechanical ventilation, clinical manifestitions, laboratory examination, treatment and prognosis.Results and prognosis The general information of two groups such as gender, age, and the time from the beginning to mechanical ventilation had no statistically significant difference (P>0.05), but the time from admission to mechanical ventilation of the two groups had significant difference (P<0.05). x2test was administered in the analysis of clinical manifestation in both group, in which abnormal eyeball movement, coma, the change of respiratory rhythm, pink frothy sputum, pulmonary moist rale, heart rate≥200bpm, cyanosis, skin pattern had statistically significant difference (P<0.05). The results of routine blood test, blood biochemistry, serum myocardial enzymes and cerebral spinal fluid were had no statistically significant difference (P>0.05). The chest X-ray manifested pulmonary edema in both groups. Brainstem encephalitis and encephalomalacia were seen in cranial MRI detection of all survival group. Pulmonary rales significantly decreased or disappeared after mechanical ventilation for30min to6h in survival group and the mechanical ventilation time ranged from21h to36d. All patients died after receiving mechanical ventilation from0.5h to72h in death group.Conclusion NPE is medical emergency. The HFMD patients with nervous system damage should be observed closely to find early signs of NPE. Effective drug treatment should be carried out the clock. And mechanical ventilation should be applied timely. Thus the mortality can be reduced.