危重型手足口病的危险因素分析  

The risk factors of critical hand,foot and mouth disease

作　　者：以丹林 韦薇 韦丹[2] 

机构地区：[1]桂林市中西医结合医院儿科,541004 [2]广西医科大学第一附属医院 PICU, 南宁530021

出　　处：《中国小儿急救医学》2016年第2期87-91,共5页Chinese Pediatric Emergency Medicine

摘　　要：目的：探讨儿童重症手足口病（hand,foot and mouth disease,HFMD）重型发展为危重型的危险因素。方法通过回顾性分析2009年1月至2010年9月广西医科大学第一附属医院儿科收治的100例重型及危重型 HFMD 患儿的临床资料（重型组82例,危重型组18例）,采用单因素及多因素非条件 Logistic 回归分析比较两组临床表现、辅助检查结果的差异,探讨重型 HFMD 进展为危重型的危险因素。结果两组发病年龄大多﹤5岁,尤其是3岁以下婴幼儿居多（重型组占85.4%,危重型组占88.9%）,两组均以男孩为主,男女比例分别为2.28∶1及8.00∶1。肠道病毒71型是重症手足口病的主要病原。重型和危重型病例绝大多数有发热和皮疹,神经系统症状以肌阵挛、肢体抖动、肢体无力、嗜睡、呕吐、抽搐多见,危重型病例除了上述症状外,神经系统症状加重,出现昏迷,并伴有呼吸、循环系统严重表现。单因素分析提示年龄﹤2岁、心率增快、呼吸急促、白细胞升高、血小板升高、血糖升高、持续高热、肢体无力、肺部啰音及 X 线胸片异常改变为重型 HFMD 进展为危重型的危险因素,而多因素非条件 Logistic 回归分析显示年龄﹤2岁、心率增快、肢体无力、肺部啰音是发生危重型病例的独立危险因素。结论年龄﹤2岁、心率增快、肢体无力及肺部啰音与重型手足口病进展为危重型高度相关。Objective To explore the risk factors of severe hand,foot and mouth disease（HFMD） that progressed to critical illness among children.Methods The clinical data of 100 cases with severe and critical HFMD（82 cases were severe HFMD and 18 cases were critical）treated in the First Affiliated Hospital of Guangxi Medical University from January 2009 to September 2010 were analyzed retrospectively.We used univariate and multiple non-conditional Logistic regression analysis to compare the differences of the clinical features and laboratory examination between two groups,survey the risk factors of severe HFMD progressing. Results Most of the patients in both groups were under 5 years old,mainly under 3 years old which accoun-ted for 85.4% of severe HFMD cases and 88.9% of critical HFMD cases.The dominant sex was male in both groups,the sex ratio were 2.28∶1 and 8.00∶1 .The main pathogen was enteral virus 71 .Fever and rash were found in most of the severe and critical patients.The main neurological symptoms were myoclonus, tremors,limb asthenia,somnolence,vomiting and convulsion.Nervous system symptoms in critical cases were even worse to develop to coma and accompany with serious respiratory and circulatory manifestations.Univa-riate analysis showed that age ﹤2 years,tachycardia,tachypnea,elevated leukocyte count,platelet count and blood glucose level,persistent high fever,limb asthenia,pulmonary moist rales and changes on chest radio-graph were the risk factors that progressed to critical illness.The multiple non-conditional Logistic regression analysis showed that age ﹤2 years,tachycardia,limb asthenia and pulmonary moist rales were independent risk factors for severe HFMD cases progressing to critical illness.Conclusion The patients aged ﹤2-year-old,tachycardia,limb asthenia and pulmonary moist rales are closely related to severe HFMD cases progress-ing to fatal condition.

关 键 词：手足口病 重型及危重型 危险因素 

分 类 号：R725.1[医药卫生—儿科]