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目的:分析羚角钩藤汤合菖蒲郁金汤加减治疗重症手足口病并发中枢神经系统损害的临床疗效。方法:选取温州医科大学附属第二医院2013年6月~2015年6月收治住院的重症手足口病并发中枢神经系统损害的患儿共70例,随机分为观察组和对照组。对照组给予常规退热、镇静、抗病毒、降颅压、补液支持治疗。观察组在对照组基础上,加用羚角钩藤汤合菖蒲郁金汤加减。两组患儿疗程均为10天。对比两组患儿的临床疗效。结果:观察组治疗后发热、易惊、肢体抖动、肌无力、尿潴留、病理征、口腔溃疡和皮疹/疱疹消失时间均显著短于对照组(P<0.05)。观察组患儿治疗后WBC、空腹血糖、脑脊液常规(葡萄糖、蛋白)及脑电图(θ、δ波)恢复正常时间显著短于对照组(P<0.05)。两组患儿治疗5、10天脑脊液中白蛋白、NSE含量逐渐降低(P<0.05),观察组治疗第5、10天脑脊液中白蛋白、NSE含量显著低于对照组(P<0.05)。观察组总有效率为97.14%,显著高于对照组的74.29%(P<0.05)。两组患儿转为危重症发生率分别为0.00%和8.57%,差异无统计学意义(P>0.05)。结论:采用羚角钩藤汤合菖蒲郁金汤加减联合西医治疗可有效改善重症手足口病并发中枢神经系统损害患儿的症状及神经系统体征,促进神经功能恢复。
Objective: To analyze the clinical effect of gingtou gouteng decoction combined with aconite and tulip decoction in the treatment of severe hand-foot-mouth disease with central nervous system damage. Methods: A total of 70 children admitted to the Second Affiliated Hospital of Wenzhou Medical University from June 2013 to June 2015 were enrolled in the study. The patients with severe HFMD complicated by CNS were randomly divided into observation group and control group. Control group given conventional fever, sedation, anti-virus, reducing intracranial pressure, fluid replacement therapy. Observation group in the control group, based on the addition of rhinoceros horn hook Unstammus plus Acorus officinalis decoction. Two groups of children were treated for 10 days. Compare the clinical efficacy of two groups of children. Results: After treatment, the observation group was significantly shorter than the control group (P <0.05). Fever, easy to shake, limb jitter, muscle weakness, urinary retention, pathological sign, oral ulcer and rash / The WBC, fasting blood glucose, cerebrospinal fluid routine (glucose, protein) and EEG (θ, δ wave) in observation group returned to normal after treatment was significantly shorter than the control group (P <0.05). The contents of albumin and NSE in cerebrospinal fluid of rats in both groups decreased gradually (P <0.05). The levels of albumin and NSE in cerebrospinal fluid in the observation group on the 5th and 10th day were significantly lower than those in the control group (P <0.05). The total effective rate in observation group was 97.14%, which was significantly higher than that in control group (74.29%, P <0.05). The incidence of critically ill patients in the two groups was 0.00% and 8.57%, respectively, with no significant difference (P> 0.05). CONCLUSION: The combination of Lingtou Gouteng Decoction and Acorus officinalis Turcz. Decoction combined with Western medical treatment can effectively improve the symptoms and neurological signs of children with severe hand-foot-mouth disease complicated by central nervous system damage and promote the recovery of neurological function.