The Clinical Curative Effect Of Different Doses Of Methylprednisolone In The Treatment Of Severe Hand, Foot And Mouth Disease

Objective:To explore the clinical efficacy of different doses of methylprednisolone in the treatment of severe hand, foot and mouth disease.Method:120 children patients with severe hand, foot and mouth disease in Children’s hospital in Jiangxi province from April 2013 to October 2014 were prospectively divided into 3 groups randomly and equally. The 3 groups were patients without using methylprednisolone, patients using common dose of methylprednisolone and patients using large dose of methylprednisolone respectively. There were 40 cases in each group.The group of children without using methylprednisolone were administered intravenous immunoglobulin 1 g /(kg·d), used for two days in succession, 0.5g /(kg·each time)of 20% mannitol, q8-12 h, injected rapidly for 20-30 min to lower intracranial pressure, used the comprehensive treatment of combing 10mg/(kg·d) of ribavirin injection aiming at fighting viruses with nutritional support; physical cooling for fever; when the temperature was over 38.5 ℃, orally took 10-15 mg /(kg·each time)of acetaminophen according to the circumstances or orally took ibuprofen suspension5-10mg/(kg·each time).The group of children using common dose of methylprednisolone were administered 2mg /( kg · each time) of methylprednisolone( 1 time each day) for 3 successive days on the base of the methylprednisolone group without using methylprednisolone. The group of children using large dose of methylprednisolone were administered 10-15mg/(kg·each time)of methylprednisolone(1 time each day)for 2 successive days on the base of the methylprednisolone group without using methylprednisolone; meanwhile administered 10 mg/kg( 1 time each day) of cimetidine for 2 successive days.Observed the conversion rate, fever-clearing time, deflorescence time, startle disappearance time, drowsiness disappearance time, hospital stay and hospitalizationexpenditure of critical illness in each group, and compared the statistical significance of the three groups.Results:In the group of children without using methylprednisolone, there were 10 entering the third phase, transforming into critical illness, and the conversion rate was25%. In the group of children using common dose of methylprednisolone, there were6 entering the third phase, transforming into critical illness, and the conversion rate was 15%. In the group children using large dose of methylprednisolone, there were 6entering the third phase, transforming into critical illness, and the conversion rate was15%. There were no statistical significances( P > 0.05) in the conversion rate difference of critical illness among the 3 groups.The fever-clearing time was 25.0±16.3 hours in the group of children without using methylprednisolone. The fever-clearing time was 27.1±17.1 hours in the group of children using common dose of methylprednisolone. The fever clearance time was25.9 ± 19.1 hours in the group of children with using large dose of methylprednisolone. There were no statistical significances( P > 0.05) in the fever-clearing time difference among the 3 groups.The deflorescence time was 6.7±1.5 days in the group of children without using methylprednisolone. The deflorescence time was 7.1 ± 2.0 days in the group of children using common dose of methylprednisolone. The deflorescence time was 6.7± 1.4 days in the group of children with using large dose of methylprednisolone.There were no statistical significances(P>0.05)in the deflorescence time difference among the 3 groups.The startle disappearance time was 1.69 ± 0.71 days in the group of children without using methylprednisolone. The startle disappearance time was 1.88 ± 0.95 days in the group of children using common dose of methylprednisolone. The startle disappearance time was 1.82±0.97 days in the group of children with using large dose of methylprednisolone. There were no statistical significances(P>0.05)in the startle disappearance time difference among the 3 groups of children.The drowsiness disappearance time was 1.49 ± 0.82 days in the group of children without using methylprednisolone. The drowsiness disappearance time was1.12±1.05 days in the group of children using common dose of methylprednisolone.The drowsiness disappearance time was 1.08 ± 0.97 days in the group of children with using large dose of methylprednisolone. There were no statistical significances(P>0.05)in the drowsiness disappearance time difference among the 3 groups of children.The hospital stay time was 4.7±0.8 days in the group of children without using methylprednisolone. The hospital stay time was 4.8 ± 0.9 days in the group of children using common dose of methylprednisolone. The hospital stay time was 4.8±1.6 days in the group of children with using large dose of methylprednisolone. There were no statistical significances(P>0.05)in the hospital stay time difference among the 3 groups of children.The hospitalization expenditure was 11413.33 ± 4026.32 Yuan RMB in the group of children without using methylprednisolone. The hospitalization expenditure was 11316.01±2218.00 Yuan RMB in the group of children using common dose of methylprednisolone. The hospitalization expenditure was 11498.82 ± 3019.97 Yuan RMB in the group of children with using large dose of methylprednisolone. There were no statistical significances( P > 0.05) in the hospitalization expenditure difference among the 3 groups of children.No death occurred in the 3 groups of children during the hospital stay.Conclusion:The methylprednisolone can neither shorten the course of severe hand foot and mouth disease, nor improve the prognosis.