1, treatment principle In terms of treatment, if there are no complications, the prognosis of this disease is generally good and it will be cured within one week. The principle of treatment is mainly symptomatic treatment. You can take antiviral drugs, Chinese herbal medicines for clearing away heat and toxic materials, vitamins B and C, etc. Patients with complications can be intramuscular injected with gamma globulin. During the illness, it is necessary to strengthen the care of children and do a good job in oral hygiene. Rinse your mouth with normal saline or warm water before and after eating, and it is advisable to use liquid and semi-liquid food as non-irritating food. Hand, foot and mouth disease can be complicated with myocarditis, encephalitis, meningitis, flaccid paralysis, etc., so we should strengthen observation and not treat it lightly. 2, the principle of prevention, there is no specific prevention method for this disease. Strengthening monitoring and improving monitoring sensitivity are the key to control the epidemic of the disease. All localities should do a good job in reporting the epidemic situation, and kindergartens should do a good job in morning check-ups, find patients in time, collect specimens, make a clear etiological diagnosis, and disinfect patients' feces and utensils to prevent the spread of diseases. During the epidemic, parents should try to let their children go to crowded public places as little as possible to reduce the chance of infection. Hospitals should strengthen prevention and set up special consultation rooms to prevent cross-infection. In the epidemic area of hand, foot and mouth disease with serious complications, weak infants who are in close contact with patients can be injected with gamma globulin intramuscularly. 3. Prevention and control measures Hand, foot and mouth disease spreads in various ways, and infants are generally susceptible. Doing a good job in children's personal, family and kindergarten health work is the key to prevent this disease infection. 10 disinfection method for preventing hand, foot and mouth disease [1] excreta container: 500 mg chlorine-containing disinfectant per liter, used for 120 minutes. Patient's clothes and sheets: boil for 20 minutes or disinfect with 500 mg chlorine-containing disinfectant per liter for 30 minutes. Mosquitoes and flies: 5% Fendana, 2.5% Deltamethrin or other pesticides can be used according to the instructions. Drinking water: use 1mg-3mg chlorine-containing disinfectants, such as bleaching powder and Youchlorine, for 30min per liter. Household appliances, books, toys and vehicles: wipe and disinfect with effective chlorine disinfectant for 30 minutes, or use 0.3% peracetic acid for 60 minutes, or directly irradiate with ultraviolet lamp for 30 minutes. Garbage: spray with chlorine-containing disinfectant solution per liter 1000 mg 120 minutes. Tableware and drinking utensils: use 250 mg of chlorine-containing disinfectant solution per liter for 30 minutes. Domestic sewage: use chlorine-containing disinfectant of 50 mg per liter of available chlorine 120 minutes. The Ministry of Health recently issued an announcement to remind catering units and consumers to take preventive measures to prevent food-borne parasitic diseases in view of the health risks of eating fresh aquatic products infected with food-borne parasitic diseases. Human and animal excrement: quicklime can be evenly mixed with it according to the ratio of 1: 1 for disinfection. Toilets or other contaminated floors and walls: disinfect with 500 mg chlorine-containing disinfectant per liter. The dosage is 200ml per square meter. Dry toilets can also be covered with quicklime.
Nursing countermeasures
1, Disinfection and isolation Once hand, foot and mouth disease is found, the baby should seek medical attention in time to avoid contact with the outside world, usually for 2 weeks. Baby's used items should be thoroughly disinfected: they can be soaked with chlorine-containing disinfectants, and items that are not suitable for soaking can be exposed to the sun. The baby's room should be ventilated regularly to keep the air fresh, circulating and at the right temperature. Conditional families can use lactic acid fumigation for air disinfection every day. Reduce the number of people entering and leaving the nursery, prohibit smoking, prevent air pollution and avoid secondary infection. 2, diet and nutrition If you get sick in summer, your baby is likely to cause dehydration and electrolyte disorder, and you need proper hydration and nutrition. The baby should stay in bed 1 week and drink plenty of warm water. Because of fever and oral herpes, the child has a bad appetite and is unwilling to eat. It is advisable to give your baby a light, warm, delicious and digestible soft liquid or semi-liquid, and avoid irritating foods such as cold, spicy and salty. 3, oral care baby will refuse to eat, drool, cry, sleep because of oral pain. Keep your baby's mouth clean, rinse your mouth with normal saline before and after meals, and gently clean your mouth with a cotton swab dipped in normal saline for babies who can't rinse their mouth. Vitamin B _ 2 powder can be directly applied to oral erosion, or cod liver oil, or taken orally with vitamin B _ 2 and vitamin C, supplemented by ultrasonic atomization inhalation, so as to relieve pain, promote the early healing of erosion and prevent secondary bacterial infection. 4, rash care baby clothes, bedding should be clean, clothes should be comfortable, soft, and often replaced. Cut your baby's nails short and wrap your baby's hands if necessary to prevent scratching the rash. Babies with a rash on their buttocks should clean up their urine and urine at any time to keep their buttocks clean and dry. Calamine lotion can be applied at the initial stage of hand and foot rash, and 0.5% iodophor can be applied when herpes forms or breaks. Pay attention to keep the skin clean to prevent infection. Hand, foot and mouth disease in children is generally a low or moderate fever, which can make the baby drink more water without special treatment. Physically cool the baby whose body temperature is between 37.5℃ and 38.5℃, such as dissipating heat, drinking more warm water and taking a warm bath. The first is holistic care, which should give children the best support. When a child suffers from any disease, the infection of any disease can be well controlled if the whole body resistance is in a good state. Because the infection of hand, foot and mouth disease is mainly virus infection, at present, we still give priority to supportive therapy, there is no special treatment, and we also advocate the use of ribavirin, but the overall effect is not very satisfactory. Because antiviral drugs are generally best used 24 to 48 hours before onset. Often, when we diagnose hand, foot and mouth disease, we have passed the most effective treatment stage, and now we do not advocate the use of these antiviral drugs. In general, it is still necessary to improve children's own resistance. For example, provide children with a digestible diet and maintain a certain amount of water. If the child's body temperature is higher than 38 degrees Celsius, use appropriate antipyretics to control the body temperature in a more suitable temperature range. If the child has aphtha, let the child gargle with 1% light salt water or warm water frequently, which can control the pain to a lesser degree. If the child's oral pain or ulcer is serious, parents can take the child to the hospital, and doctors can use some antibiotic ointment or local anesthetic liquid to relieve the child's pain. The rash on the child's body is mainly to keep it clean and tidy, and don't let the skin get infected again. That's all that matters. If there are no complications, under normal circumstances, children can recover in 5-7 days under a good nursing atmosphere.
Western medicine treatment
If there are no complications, most children with hand, foot and mouth disease can recover within one week. The principle of treatment is mainly symptomatic treatment, taking vitamins B and C and antiviral drugs under the guidance of doctors. In addition, hand, foot and mouth disease can be combined with myocarditis, encephalitis, meningitis and other diseases, and should be reviewed in time. Western medicine treatment of hand, foot and mouth disease is as follows: 1) Contacts should pay attention to disinfection and isolation to avoid cross infection; 2) closely monitor the changes of the disease, especially the functions of important organs such as brain, lung and heart; Critical patients pay special attention to monitoring blood pressure, blood gas analysis, blood sugar and chest X-ray; 3) Strengthen symptomatic support treatment and do oral care well; 4) Pay attention to maintaining the balance of water, electrolyte and acid-base, and protect important organs; 5) People with increased intracranial pressure can be given dehydration treatment such as mannitol, and those with severe intracranial pressure can be given drugs such as methylprednisolone and intravenous gamma globulin as appropriate; 6) Patients with signs of respiratory failure such as hypoxemia and dyspnea should be treated with mechanical ventilation as soon as possible; 7) Keep blood pressure stable and give vasoactive drugs when necessary; Other severe treatment: if DIC, pulmonary edema and heart failure occur, corresponding treatment should be given. Hand, foot and mouth disease is a common infectious disease in infants. Coxsackie virus A 16 and enterovirus 7 1 * * are considered as the main causes of the epidemic. The disease was first seen in China and Shanghai from 198 1, and has been reported in many provinces and cities since then. The main clinical manifestations of the disease are fever, rash and ulcer on hands, feet and mouth, and some patients can cause fatal complications such as myocarditis, pulmonary edema and aseptic meningoencephalitis. On May 2, 2008, hand, foot and mouth disease was officially listed as a Class C infectious disease in China for legal infectious disease management. At present, there is no recognized specific treatment for this disease, and the drug treatment of this disease is summarized as follows. 1 western medicine treatment of hand, foot and mouth disease in children 1. 1 acyclovir acyclovir is an acyclic purine nucleotide analog. Its antiviral effect is that after the drug enters the cells infected by herpes virus, it competes with deoxynucleoside for viral thymic kinase or cytokinase, and the drug is phosphorylated with live acyclovir triphosphate, and then the virus replication is inhibited in two ways: ① the polysaccharide that interferes with viral DNA inhibits virus replication; ② Under the action of DNA polysaccharide, it combines with the growing DNA chain, resulting in the interruption of DNA chain extension. The therapeutic dose was 20 mg/kg, 10% glucose solution was added 100 mL intravenous drip, 1 time/d; Or acyclovir 5 ~10 mg/(kg d) orally, three times a day. Acyclovir, as an efficient and broad-spectrum antiviral drug, can obviously shorten the healing time of fever and skin lesions and relieve the pain of oral herpes, and has no side effects during the treatment [1]. 1.2 ganciclovir ganciclovir, also known as ganciclovir, is a newly developed broad-spectrum nucleoside antiviral drug after acyclovir. The antiviral effect is similar to acyclovir. The therapeutic dose is 5 ~ 10 mg/kg, 10% glucose solution is added 100 mL intravenous drip, 1 time /d, and the course of treatment is 3 ~ 5 days. Use antibiotics and antipyretics as appropriate during medication. Huang Shixiong's research shows that ganciclovir is better than ribavirin in the treatment of hand, foot and mouth disease, and the time for fever and herpes to subside is significantly shorter than that of ribavirin. However, the inhibitory effect of ganciclovir on bone marrow and its long-term side effects need further study. The study of Chen [3] shows that the curative effect of ribavirin injection combined with ganciclovir in the treatment of hand, foot and mouth disease in children is better than that of any of the above drugs alone. Interferon 1.3, as a powerful antiviral agent, has obvious curative effect on many viral infectious diseases and has been widely used in clinic. The therapeutic dose is 1 ten thousand IU intramuscular injection, 1 time /d, and its therapeutic mechanism is to prevent virus replication by blocking the translation of virus mRNA in cells and inhibiting the synthesis of virus RNA, and at the same time to enhance the host immunity by enhancing the activity of natural killer lymphotoxin. Appropriate application of interferon can improve the cellular immunity of the body, inhibit the virus and promote the recovery of the body [4]. Gong Hu et al. [5] research shows that interferon combined with Xiaoer Qingre Ning and other traditional Chinese medicine preparations have obvious curative effect on hand, foot and mouth disease. Ribavirin 1.4 Ribavirin, as a commonly used antiviral drug, is effective in treating hand, foot and mouth disease in children. The therapeutic dose was 10 mg/kg, 10% glucose solution was added 100 mL intravenous drip, 1 ~ 3 times /d for 3 days. ; Or ribavirin buccal tablets 1/4 ~ 1/2 tablets, four times a day. Use antibiotics and antipyretics as appropriate during medication. The side effects are little sweating, loss of appetite and hypoglycemia. At present, this medicine is not the first choice for treating hand, foot and mouth disease in some big hospitals. But because of its few side effects, low price, safety, reliability and high curative effect, it is suitable for popularization and use in primary hospitals [6]. 1.5 The effective component of smecta smecta is octahedral montmorillonite particles, which have a layered molecular structure, have strong fixation, adsorption and removal effects on viruses, bacteria and toxins produced in the digestive tract, have strong covering ability on the digestive tract mucosa, can bind with mucin, improve the defense function of the mucosal barrier against attack factors, and promote the recovery and regeneration of epithelial tissues. For children with hand, foot and mouth disease, especially children with severe oral ulcer, a proper amount of smecta is stirred into paste with warm boiled water four times a day and applied to the oral ulcer area at morning, noon, evening and before going to bed, which can obviously shorten the healing time of oral ulcer in children without obvious toxic and side effects. Smecta is sweet, easy to be accepted by children, and worthy of clinical promotion [7]. The treatment of hand, foot and mouth disease in children with traditional Chinese medicine belongs to the category of "damp-warm" and "epidemic" in traditional Chinese medicine. The disease is caused by the prevalence of damp-heat, mostly due to internal damp-heat and external pathogens, and stays in the lungs, spleen and heart. Exogenous pathogens enter from the nose and mouth, invade the lung and spleen meridians, and the lung dominates the fur, so early lung health symptoms such as fever, runny nose and cough are common; The spleen governs the limbs and the mouth is enlightened. Hands, feet and mouth are affected by evil, resulting in blisters, herpes and ulcers on the mouth and tongue. At present, Chinese medicine mainly adopts three basic methods to treat this disease: syndrome differentiation, disease differentiation and staging, and special prescription addition and subtraction. It can not only reach the standard, but also reach the cost, relieve symptoms and shorten the course of disease.
Traditional therapy in China
Common type (accumulation of heat in heart and spleen): fever, anhidrosis, hand, foot and mouth herpes, in which the herpes in mouth and tongue is red and the pain is severe. The child drools a lot, loses appetite, can't eat, is constipated, has a red tongue and yellow greasy fur. Traditional Chinese Medicine: Prescription for clearing away heat and toxic materials and eliminating dampness: Dahuang Huanglian Xiexin Decoction: 3 grams of rhubarb, 6 grams of scutellaria baicalensis, 3 grams of coptis chinensis, 6 grams of gallnut, 6 grams of mint, and 50 ml of water decoction, taken twice. Common type (damp-heat resistance): fever without sweating, herpes on the hands, feet and lips, dark red color of herpes on the lips and tongue, mild pain, abdominal distension, anorexia, normal or slightly sticky stool, red tongue, white greasy or slightly yellow greasy fur. Traditional Chinese medicine: pungent and bitter, clearing away heat and eliminating dampness. Prescription: Gancao Xiexin Decoction: Radix Glycyrrhizae 10g, Rhizoma Pinelliae 6g, Radix Scutellariae 6g, Rhizoma Coptidis 2g, Rhizoma Zingiberis, Radix Bupleuri 10g, and Herba Agastaches 6g, decocted in water for 50ml twice. Severe (central nervous system infection): fever, rash, high fever, no sweat, fidgety, lethargy, irritability, easy to shock, or flaccid paralysis of limbs, red tongue, white or yellow greasy fur. Chinese medicine: clearing heat and promoting diuresis, calming the liver and calming the wind. Prescription: Yin Feng decoction: 3 grams of rhubarb, 20 grams of gypsum, mirabilite10g, talc10g, halloysitum rubrum10g, white stone fat10g, and viologen10g. Intense addition and subtraction scheme: strong thermal potential, plus antelope horn powder; For severe limb clonus, Coicis Semen, Lumbricus and Fructus Chaenomelis are added; Constipation reduces halloysitum rubrum, diarrhea reduces rhubarb, reduces gypsum dosage, and adds Cimicifuga rhizome and Radix Puerariae; For patients with limb paralysis, fresh lumbricus, Gentiana macrophylla, Radix Clematidis and Luffa (damp-heat syndrome differentiation formula) are added; Later antipyretic and calculus-reducing drugs, benefiting qi and nourishing yin, clearing heat and dredging collaterals.
How to relieve oral pain of hand, foot and mouth baby?
Now it has entered the high season of hand, foot and mouth disease. Up to now, the number of confirmed cases of hand, foot and mouth disease in many provinces and regions in China has reached 654.38+10,000, which makes parents of children everywhere very worried. According to this expert, hand, foot and mouth disease is a common and frequently-occurring disease. Generally, it can heal itself in 7 ~ 10 days, and there is no need to panic at all. For the prevention of hand, foot and mouth disease, experts reminded that because saliva is one of the main transmission routes of hand, foot and mouth disease, susceptible people should pay special attention to oral care and anti-inflammation. The most typical clinical manifestation of hand-foot-mouth disease is round or oval skin maculopapules on the palms, soles and buttocks of children, especially herpes in the mouth, which is mostly distributed in the tongue, buccal mucosa, lips, hard palate, pharynx and tonsils. It is very painful to form an oral ulcer after bursting. In severe cases, it will affect children's eating and children will cry. Medical experts tell parents that oral care for children can effectively relieve pain and promote the healing of ulcer surface. Expert guidance: wash your baby with normal saline before and after meals; For babies who can't gargle, you can gently clean your mouth with a cotton swab dipped in normal saline. For children with relatively serious symptoms of oral ulcer, attention should be paid to alleviating children's oral pain while taking medication. Vitamin B2 powder or cod liver oil can be directly applied to oral erosion parts to promote the early healing of erosion. In addition, some patients reacted. Huasu tablets are ground into powder and coated on the ulcer surface with cotton swabs, and the effect is very good. The main component of Huasu tablet "Xidi Iodine" can quickly kill all kinds of pathogenic microorganisms in the oral cavity, thus effectively astringing and reducing swelling, improving the blood circulation on the ulcer surface, quickly relieving the pain caused by oral ulcer to children, and promoting the healing of baby's damaged oral mucosa. In addition, it is appropriate to give your baby light, warm, delicious, digestible and soft liquid or semi-liquid food at this time, and avoid eating irritating foods such as cold, spicy and salty.
Precautions for prevention and control of hand, foot and mouth disease
1. Improper prevention and treatment of hand, foot and mouth disease will lead to serious consequences. With correct prevention and control, hand, foot and mouth disease can be prevented, controlled and treated, and it is not terrible. Parents and teachers of children under five should check their children's hands, feet and mouth for herpes and fever every day while doing personal hygiene. If you have herpes or fever, you should go to a regular medical institution immediately. Fortunately, relying on the prevention and control of the health department, going to the rural clinic for simple symptomatic treatment with herpes and fever will delay the favorable opportunity for treatment, which is the main reason for the child's serious illness and death. 2. Children who are cured and discharged from hospital still have infectious hand, foot and mouth disease within three weeks. Parents often think that everything is fine, so they can walk around the streets and go to other people's homes to find their children to play with. In fact, the child is still a carrier within three weeks after being cured and discharged from hospital, and can still spread the virus. Should be isolated at home for three weeks. Otherwise, it will not only infect children nearby, but also infect other types of viruses. 3. Most children infected with the virus are brought home by their parents from outside and come into contact with children with hand, foot and mouth disease. Parents often think that they are innocent and will not find reasons from themselves. Most of the viruses infected by children are brought home by parents from outside. It is necessary to vigorously carry out household hygiene and cleaning actions, eliminate sanitary dead ends, do not take children to crowded public places, pay attention to family and personal hygiene, and keep in mind the prevention and control measures of "paying attention to hygiene, washing hands frequently, eating cooked food, drinking boiled water, drying clothes and quilts, and ventilating frequently". 4. Practice has proved that taking the recommended Chinese herbal medicine prescription under the guidance of medical staff can effectively prevent hand, foot and mouth disease [4].
Nine Questions and Nine Answers on Prevention and Treatment of Hand, Foot and Mouth Disease
1, what is hand, foot and mouth disease? What is the performance after getting sick? Hand-foot-mouth disease (HFMD) is a common infectious disease, which mainly occurs in infants and can be caused by a variety of enteroviruses, among which EV7 1 virus is one. Generally, it occurs all year round, and the high incidence period is May-July. The symptoms of hand, foot and mouth disease are generally mild. When most patients get sick, they often have fever symptoms first, maculopapules and herpes (redness around the rash) appear on the palms and soles, and herpes or ulcers appear on the oral mucosa, with obvious pain. Some patients may be accompanied by cough, runny nose, loss of appetite, nausea, vomiting, headache and other symptoms. A few patients are seriously ill and may be complicated with encephalitis, meningitis, myocarditis and pneumonia. If not treated in time, it may endanger life. 2. How is hand, foot and mouth disease spread? Is there a vaccine? Hand, foot and mouth disease spreads through many ways, mainly through close contact with patients' feces, herpes fluid and respiratory secretions (such as sneezing droplets). ) and contaminated hands, towels, handkerchiefs, tooth cups, toys, tableware, bottles and bedding. There is no vaccine for hand, foot and mouth disease at present, but it can be completely prevented and treated as long as it is found and treated early. 3. Who is prone to hand, foot and mouth disease? Infants and young children are more common, and infants and young children aged 3 and below are more likely to get sick. Because the adult's immune system is relatively perfect, once infected, adults generally do not get sick and have no symptoms. However, the virus will spread after infection, so adults also need to be well protected to avoid infecting children. 4. Is hand, foot and mouth disease a new infectious disease? Hand, foot and mouth disease is not a new infectious disease, but a global infectious disease. It was first identified and named in 1957, and cases occur every year all over the world. Hand-foot-mouth disease was discovered in China by 198 1, and people get sick every year. 5. Can hand, foot and mouth disease be cured? If you get hand, foot and mouth disease, in most cases, you can heal yourself in 7- 10 days, leaving no sequelae and no scars on your skin. According to the past incidence and cure, only a few critically ill patients may have meningitis, pneumonia and so on. As long as you actively cooperate with doctors, most of them can be cured. 6. What should I do if my child has suspicious symptoms? If the child has symptoms such as fever and rash, he should go to a medical institution in time and observe closely. Don't go to kindergartens and public places where people gather, and avoid contact and play with other children. Such as sudden high fever or unconsciousness, lethargy, muscle or body twitching, dyspnea, etc. The child should be taken to the hospital at once. 7. How do ordinary families prevent it? The key to prevent hand, foot and mouth disease is to pay attention to the hygiene of family and surrounding environment and personal hygiene. Wash your hands with soap or hand sanitizer before and after meals and going out; Do not drink raw water or eat cold food; The room should be ventilated frequently; Often dry clothes and quilts. During the epidemic, children should not be taken to public places with dense crowds and poor air circulation, and contact with sick children should be avoided. During the epidemic, you can check your child's skin (mainly palms and soles) and mouth for abnormalities every morning, and pay attention to the changes of your child's body temperature. 8. If a child is infected at home, what should I pay special attention to? Pay attention to keep sick children away from other children; Children's saliva, phlegm and other secretions should be wrapped in toilet paper and thrown into the trash can. Children's feces should be collected, disinfected and thrown into the toilet. Don't throw it away at will, the bedpan should be disinfected. Nurses should wash their hands before touching children, after changing diapers or after handling children's feces; Clothes, toys, tableware, pillows and bedding of sick children should be kept clean, and children's daily utensils should be disinfected; Always open the window for ventilation. If a child in kindergarten is ill, tell the teacher as soon as possible, and don't rush to let the child go to kindergarten. They should go a week after all the symptoms disappear to prevent other children from being infected. Generally, the symptoms are mild without hospitalization, so family treatment and rest can be used to reduce cross-infection. 9. How to disinfect daily necessities? If there are no children with hand, foot and mouth disease at home, you can use ordinary family methods to prevent it without disinfectant. If the children at home have hand, foot and mouth disease, they can be disinfected by the following methods: pacifiers, bottles, tableware, towels and other items are soaked in hot water of more than 50 degrees for 30 minutes or boiled for 3 minutes; Contaminated toys, tables and chairs, clothes, etc. Clean with chlorine-containing disinfectant (84 disinfectant or bleaching powder) according to the instructions every day; Children's sputum, saliva and feces, wiping paper, etc. It's best to pour an appropriate amount of disinfectant, stir and disinfect it before throwing it into the toilet.
Good hygiene habits should be maintained to prevent hand, foot and mouth disease.
Hand-foot-mouth disease (HFMD) is a common disease in infants and children. The key to prevention and control is that parents should maintain good hygiene habits. It is understood that hand, foot and mouth disease is characterized by fever, oral ulcers and herpes. The initial symptoms are low fever, loss of appetite, physical discomfort, and often accompanied by sore throat. Oral ulcer appeared in fever 1-2 days, which started with red herpes and later became ulcer. 1-2 days later, maculopapules of the skin can be seen, some of which are herpes, and the rash is not itchy, which is common in palms and soles, and can also appear in buttocks. Some patients only have rashes or oral ulcers, which are usually not serious. Almost all patients can be cured within 7- 10 days without treatment.