通过对手足口病(hand-foot-and-mouth disease, HFMD)重症死亡病例分析，提高对该病特点和治疗的认识及抢救成功率，降低死亡率。

选取2010年1月至12月本院因重症手足口病导致死亡的13例患儿的完整病历资料为研究对象(本研究遵循的程序符合本院人体试验委员会的标准)。采用回顾性分析法对其年龄、性别、首发症状、体征、实验室检查结果、死亡时间和尸检结果进行分析。

13例死亡患儿中，年龄最大为8岁10个月，最小为2个月＋29 d，69.23%(9/13)患儿<3岁。死亡时间均为发病后4 d内，92.30%(12/13)为发病后72 h内，以男性为主(92.30%，12/13)。全部患儿病程中均突发气促、呼吸困难加剧、心率增快及肺部突然出现干、湿啰音等肺水肿及肺出血临床症状。辅助检查发现，77.00%(10/13)患儿白细胞(white blood cell，WBC)计数及中性粒细胞升高，接受血糖测定的8例患儿血糖均升高，临终前接受胸部X射线摄片检查的9例患儿均有不同程度改变，表现为肺水肿、肺出血(40%右肺病变为重)。病原学检测结果示61.54%(8/13)患儿肠道病毒(enterovirus 71，EV71)呈阳性，7.60%(1/13)柯萨奇A组病毒(Coxsackievirus A, COXA) 16呈阳性。2例尸检结果显示，脑干脑炎、肺水肿及肺出血相关病理学改变。

对非典型手足口病患儿，在手足口病流行早期，必须警惕以发热、呕吐或气促(无其他呼吸道症状)为首发症状患儿，行MRI或CT检查排除脑干脑炎，警惕肺水肿和肺出血发生。对高度可疑手足口病患儿须留院观察。早诊断、早治疗和及时抢救，可提高该病抢救成功率，降低死亡率。

To improve the recognition of severe hand-foot-and-mouth disease (HFMD) through death cases.

From January to December 2010, 13 death cases who were diagnosed as severe hand-foot-and-mouth disease were included into this study. Their age, gender, initial symptoms, signs, laboratory findings, time of death and autopsy results were retrospectively analysed.

There were 69.23% sufferers (n=9) who were less than 3 years old among 13 cases. The death time of all cases was not more than 4 days after outbreak, and 92.30% of them (n=12) were dead in 72 hours. Most suffers were boys(12/13, 92.30%). All cases suddenly showed clinical symptoms of tachypnea, dyspnea, heart rates increased and signs of pneumonedema or/and pneumorrhagia. 77.00%(10/13) cases had increased white blood cell(WBC) count, neutrophil and blood sugar, who also had chest X-ray changes in different degrees and signs of pneumonedema and pneumorrhagia just before dying. 61.54% suffers (n=8) had positive result of enterovirus 71(EV71) test, meanwhile 7.69% suffers (n=1) had positive result of Coxsackievirus-A (COXA) 16 test. There were pathological change of brain stem encephalitis, pneumonedema and pneumorrhagia in 2 autopsied cases.

We should pay attention to patients with untypical hand-foot-and-mouth disease who had fever, vomit and tachypnea (no other respiratory passages symptom) as initial symptoms in early term, perform MRI or CT to differentiate brain stem encephalitis, and prevent from pneumonedema and pneumorrhagia. Highly suspected patients of hand-foot-and-mouth disease should be observed carefully in hospital. The key to increase survival rate and decrease mortality lies in diagnosing, treating and rescuing as early as possible.