腸病毒71型重症概論

Enteroviral 71 Infection-A Critical Review

謝凱生(Kai-Sheng Hsieh) ； 張嘉侃(Jia-Kan Chang)

《重症醫學雜誌》 9卷3期 (2008/09) Pp. 168-173

https://doi.org/10.30035/TCCM.200809.0003

摘要

腸病毒(Enterovirus)今年在台灣造成相當大的流行病震撼，其重症案例到今年8月中旬爲止，已導致10名病童死亡，通報重症案例多達343例，對疫情流行臨床醫療以及社會群眾心理都形成極爲嚴峻的桃戰，由於本症是一種新興傳染病，值得大家對此做更多的了解，以便能及時採取措施，阻斷相關重症的流行並減少重症死亡率及後遺症之發生率。現在醫界習慣上將腸71型病毒之一般性之感染或是重症案例通稱爲「腸病毒感染」其實並不是挺恰當，腸71型病毒感染有其特殊異於其餘腸病毒感染之臨床症候，尤以重症病例爲然，筆者建議應稱之爲「腸71型病毒症候群］或者稱之爲「病毒性腦榦症候群」以避免混淆，符合實情。腸71型病毒症候群的臨床症狀，多數均有手足口症或瘡疹性咽峽炎，但亦有一定比例的患兒並未呈現手足口症的現象，重症病兒多數有神經學上肌躍式抽搐(Myoclonus)的現象，神經學症狀中，睡眠／意識障礙的約近一半，另部份會合併嘔吐現象。腸71病毒性症候群的臨床病程，初期腸病毒屬克沙奇及伊科病毒的皮膚黏膜症候類似，均可呈手足口症或是瘡疹性咽峽炎的症候，但是腸71病毒感染之患兒會可能繼續演進成神經學的症候並可能進而發生肺水腫及心肺衰竭的現象，而克沙奇及伊科病毒感染之患者則在發生皮膚黏膜症候之後會回歸到恢復期。分期治療的觀念引入，使得腸71型病毒症候群患兒的治療能依病兒出現症候的嚴重程度而提供不同範籌的重症照護，臨床上已顯示腸71型病毒症候群的分期治療可以明顯的降低病兒的死亡率，值得大家採行。腸71型病毒症候群爲一新興傳染病，自1998年大舉侵台以來，每年均多少造成一定程度之重症案例，影響社會人心至鉅，謹就目前所知所識，參考相關文獻並結合筆者10餘年來照護腸71病毒症候群患兒之臨床經驗，做成本症候群處置相關之重症綜合論述，期望能對兒科同道提供參考訊息，大家齊心努力，抗疫爲重！

關鍵字

腸71型病毒症候群

並列摘要

During the past 10 years, enteroviral 71 infection has caused significant psychosocial negative impact in Taiwan. Apparently this emerging infectious disease will alert pediatric health care professionals to take more effort to combat this serious illness.
In Taiwan, traditionally the new illness caused by enteroviral 71 infection is called ”Enterovirus Infection”. The authors feel that it is a misnomer because there are many different types in enterovirus. For example, poliomyelitis is caused by poliovirus which is also an enterovirus but we never called poliomyelitis as enterovirus infection. Therefore the authors recommend a new term ”Enterovirus 71 syndrome” or ”Brainstem viral syndrome” instead of the traditional nonspecific ”Enterovirus infection” to avoid misleading and confusion.
Usually there are no specific laboratory findings for the laboratory diagnosis of enteroviral 71 syndrome except viral-targeted microbiology tests such as viral culture, serology or PCR-related tests. However, many of the drawbacks with these microbiological tests limited its application in the early diagnosis of enteroviral 71 syndrome.
Therefore we must rely on the early clinical detection of enteroviral 71 syndrome. Although hand-foot-mouth disease or herpangina is often associated with enteroviral 71 syndrome, many patients with enteroviral 71 syndrome lack such presentations. The spectrum of enteroviral 71 syndrome is currently durided into 4 stages: 1. Hand-Foot-Mouth/Herpangina or nonspecific viral syndrome stage. 2. Neurological stages with conscious change, seizure, myochonic jerks or motor palsy. 3(A) Sympathetic stimulation stages 3(B) Decompensated stage with extreme tachycardia/hypertension and soon followed my cardiopulmonary decompensation. 4. Recovery stage.
The management of enteroviral 71 syndrome depends on the clinical stages of patients. Careful monitoring is needed to close and precise recognition of different stages so that appropriate measures could be undertaken.
In summary, enteroviral 71 syndrome is an emerging disease with possible serious complications. Every pediatrician should be alerted to this new syndrome and be familiar with its management to maximize clinical outcome!

並列關鍵字

Enteroviral 71 Syndrome