Abstract: 【Objective】 To analyze the epidemiologic and clinical features of 53 fatal cases of hand, foot and mouth disease(HFMD) in Shandong province in 2009-2010,so as to provide scientific basis for reducing mortality and optimizing treatments for severe cases. 【Methods】 Epidemiological investigations and laboratory tests were carried out on these fatal cases,and descriptive epidemiology was used to analyze acquired information. 【Results】 The average age of fatal cases was 1 year 6 months,and cases under 2-year-old accounted for 83.0%.The number of deaths from rural areas was larger than that of urban areas.The death ratio between male and female was 3.4∶1.Death cases were dominated by EV71 infection(13/15),with the average course (82.4±4.7) h.96.9% cases had fever from onset,then rash occurred after 1.06 days.Most cases also had other clinical manifestations, such as convulsion,irritability,lethargy,myoclonic twitching,short of breath,dyspnea,respiratory rhythm changes,pink foaming from mouth,lung moist rale,cardiac rhythm changes or vomiting.Primary causes of death was ranked as neurogenic pulmonary edema (96.9%),encephalitis (65.6%) or respiratory and circulatory failure (46.9%). 【Conclusions】 Death cases under 2-year-old had shorter course and higher case fatality rate. In order to reduce deaths of HFMD,it is of vital importance to strengthen monitoring of severe patients, to enhance the ability of early recognition and sensitivity of severe clinical manifestations,to take treatment earlier and to slow down the progression of the disease.

Key words: hand, foot and mouth disease, fatal case, epidemiology, clinical manifestation

摘要： 【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1.06 d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。

关键词: 手足口病, 死亡病例, 流行病学, 临床表现