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目的探讨重症、轻症手足口病临床表现及就诊过程中的影响因素,为手足口病防控、管理提供科学依据。方法单纯随机抽取开封市102例手足口病病例开展病案和电话调查,对病人的临床表现及就诊情况进行分析。结果手足口病临床表现以发热(78.43%)、出疹(99.02%)多见;57.84%可见精神差、惊颤、呕吐、咳嗽等其他症状;37.25%出现病毒性脑炎、支气管炎等并发症和合并症。重症与轻症病例相比最高体温较高(t=3.86,P<0.05)、先发热后出疹的较多(χ2=4.96,P<0.05)、可见嗜睡、肢体肌阵挛等特有症状且出现较晚,首诊不易确诊(χ2=12.77,P<0.05)。首诊医院中,县及县以下医院就诊率重症高于轻症(χ2=16.32,P<0.05),但确诊率重症低于轻症(χ2=5.27,P<0.05)。结论本研究结果表明,重症手足口病病例早期症状不典型,县及县以下基层医院易误诊。建议开展基层医务人员手足口病诊治技术培训,提高对手足口病的诊断鉴别能力。
Objective To explore the clinical manifestations of critically ill patients with mild to moderate hand-foot-mouth disease and influencing factors in the process of diagnosis and provide a scientific basis for the prevention and control of hand-foot-mouth disease. Methods A total of 102 cases of hand, foot and mouth disease in Kaifeng city were randomly selected to carry out medical records and telephone surveys. The clinical manifestations and treatment of the patients were analyzed. Results The clinical manifestations of hand, foot and mouth disease were fever (78.43%), rash (99.02%) were more common, 57.84% showed poor mental performance, such as shivering, vomiting and coughing, and 37.25% were viral encephalitis and bronchitis Symptoms and complications. Severe and mild cases compared to the highest body temperature was higher (t = 3.86, P <0.05), after the first fever more rash (χ2 = 4.96, P <0.05), drowsiness, limb myoclonus and other symptoms can be seen and Appeared later, the first diagnosis is not easy to diagnose (χ2 = 12.77, P <0.05). The first visit to the hospital, county and county hospitals were significantly higher than the severity of critically ill (χ2 = 16.32, P <0.05), but the diagnosis was significantly less severe than mild (χ2 = 5.27, P <0.05). Conclusion The results of this study show that the early symptoms of severe hand-foot-mouth disease are not typical, and the primary hospitals below the county level are easily misdiagnosed. It is recommended to carry out technical training of hand-foot-mouth disease diagnosis and treatment of grass-roots medical staff to improve the ability of the diagnosis of hand-foot-mouth disease.