Wang Jieh-Neng, Yao Chih-Ta, Yeh Cheng-Nan, Huang Chao-Ching, Wang Shih-Min, Liu Ching-Chuan, Wu Jing-Ming
Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Pediatr Int. 2006 Jun;48(3):250-6. doi: 10.1111/j.1442-200X.2006.02198.x.
The aim of this study was to analyze clinical details occurring in children with severe enterovirus 71 (EV71) infection and synthesize the critical care experience for patients with severe EV71 infection.
A retrospective clinical, laboratory, and hemodynamic study was performed in a pediatric intensive care unit in a university hospital. From March 1998 to April 2000, seven consecutive pediatric patients with severe EV71 infection were retrospectively analyzed as the comparison group. From May 2000 to March 2003, eight consecutive patients with severe EV71 infection who had received the protocol therapy were enrolled as the study group. Detailed information about clinical treatment and pharmacological therapy was collected for comparison.
The clinical presentations and laboratory findings between the comparison and the study groups were not significantly different. The amount of intravenous fluid in the first 24 h was significantly higher in the comparison group (9.2+/-5.0 vs 4.9+/-1.3 mL/kg per h). More patients in the study group received low doses of dopamine infusion, patients in the comparison group received more epinephrine, and none of them received milrinone. The acute-stage and long-term survival rates were higher in the study group (100% vs 43%, 87% vs 29%).
Early cardiopulmonary support may prevent the vicious cycle of cardiopulmonary failure and improve the clinical outcome of severe EV71 infection. Milrinone may be the ideal inotropic agent for these patients. Echocardiography, a central line, and an arterial line could be an alternate method to replace direct intracardiac hemodynamic monitoring for guiding critical management.
本研究旨在分析重症肠道病毒71型（EV71）感染患儿的临床细节，并总结重症EV71感染患者的重症监护经验。
在一所大学医院的儿科重症监护病房进行了一项回顾性临床、实验室和血流动力学研究。1998年3月至2000年4月，对7例连续的重症EV71感染儿科患者进行回顾性分析作为对照组。2000年5月至2003年3月，将8例接受方案治疗的连续重症EV71感染患者纳入研究组。收集有关临床治疗和药物治疗的详细信息进行比较。
对照组和研究组之间的临床表现和实验室检查结果无显著差异。对照组在前24小时的静脉输液量显著更高（9.2±5.0 vs 4.9±1.3 mL/kg每小时）。研究组更多患者接受低剂量多巴胺输注，对照组患者接受更多肾上腺素，且两组均未接受米力农。研究组的急性期和长期生存率更高（100% vs 43%，87% vs 29%）。
早期心肺支持可能预防心肺功能衰竭的恶性循环，改善重症EV71感染的临床结局。米力农可能是这些患者理想的正性肌力药物。超声心动图、中心静脉导管和动脉导管可能是替代直接心内血流动力学监测以指导重症管理的一种方法。
