重症手足口病并发神经源性肺水肿预后因素的研究  

Study on the prognosis factors of neurogenic pulmonary edema complicated by severe hand-foot-mouth disease(HFMD)

作　　者：刘立[1] 周吉坤[1] 焦丁琦[2] 崔荣辉[3] 

机构地区：[1]河北省石家庄市疾病预防控制中心流行病防治所,050011 [2]河北医科大学流行病学教研室 [3]石家庄市第五医院感染控制科

出　　处：《中国妇幼保健》2013年第2期241-244,共4页Maternal and Child Health Care of China

基　　金：中华预防医学会"公共卫生应用研究与疫苗可预防疾病科研资金"支持项目〔20100303〕;河北省卫生厅科研基金项目〔20120179〕

摘　　要：目的:探讨重症手足口病进展为神经源性肺水肿的危险因素。方法:选择在石家庄市第五医院就诊的重症手足口病患者按是否进展为神经源性肺水肿分组,选择性别、年龄、病原、出生体重等作为配比因素进行1∶3的配比病例对照研究。结果:单因素Logistic发现,初诊为村级医疗机构、持续高热、肢体无力、呼吸浅快或节律不规则、肺部杂音、血压≥130mmHg、心率≥150次/min、血氧饱和度≤91%、外周血白细胞计数>12×109/L、血糖>8.3 mmol/L、肌酸激酶升高、C反应蛋白阳性为重症手足口病进展为神经源性肺水肿的危险因素。多因素Logistic回归发现,持续高热、肢体无力、心率≥150次/min和血糖>8.3 mmol/L共同构成了重症手足口病进展为神经源性肺水肿的危险因素,而初诊确诊手足口病则为保护性因素。结论:并发神经源性肺水肿的患者与对照组在热峰、呼吸及循环系统表现上存在差异。临床上应密切监测特异性指标的动态变化,及早采取应对措施,减少手足口病重症病例的病死率。Objective ： To study the risk factors of severe HFMD developing to neurogenic pulmonary edema. Methods： The severe HFMD patients were selected in the Fifth Hospital of Shijiazhuang from Apr. 1, 2010 to Oct. 30, 2010 and. divided groups according to whether developing ：to ne＇drogenic pulmonary edema. Sex, age, pathogeny and the birth weight were chosen as matched factors to start the 1 to 3 matched cases - control study. Results： Single - factor logistic analysis found that the risk factors were the first diagnosis at village - level medical institutions, the highest temperature ≥ 39℃, long - term high fever, weakness of limbs, tachypnea or arrhythmias, lungs souffle, blood pressure≥ 130 mmHg, heart rate≥150 time/rain, oxygen saturation of blood ≤91%, number of peripheral white blood cells 〉 12 × 109/L, blood sugar 〉 8.3 mmol/L, the rise of creatine kinase, C reactive protein test positive. Multi- factor logistic regression analysis found that the risk factors were long- term high fever, weakness of limbs, heart rate ≥ 150 time/rain and blood sugar 〉 8.3 mmol,/L, but confirmed HFMD at the first diagnosis was a protective factor. Conclusion： There are differences in the thermal spike, respiratory and circulatory system between patients complicated by neurogenic pulmonary edema and control groups. Early diagnosis and intervention for neu- rogenic pulmonary edema can reduce the fatality rate of HFMD.

关 键 词：重症手足口病 神经源性肺水肿 预后因素 

分 类 号：R726[医药卫生—儿科]