重症手足口病87例临床特征及危险因素分析  

Analysis of Clinical Features and Risk Factors in Patients with Severe Hand-foot-mouth Disease

作　　者：徐进[1] 蒋艳平[2] 袁良玉[1] 雷辉[1] Xu Jin;Jiang Yan-ping;Yuan Liang-yu;Lei Hui(Zhuhai Maternity and Child Health Hospital, Pediatrics, Zhuhai, Guangdong, 519000, China)

机构地区：[1]广东省珠海市妇幼保健院儿科,广东珠海519000 [2]广东省珠海市妇幼保健院小儿外科,广东珠海519000

出　　处：《当代医学》2017年第12期32-35,共4页Contemporary Medicine

摘　　要：目的探寻手足口病重症化的早期预警指标,为早期识别、尽早干预提供科学依据。方法回顾性分析87例重症手足口病患儿的临床资料并进行单因素和多因素分析。结果与普通病例相比,重症病例多见于3岁以内的婴幼儿;临床常持续高热或高热难退、初期的呕吐、精神萎靡、嗜睡、易惊、惊厥、难以解释的烦躁不安、肢体抖动、震颤、肌阵挛、无力、神经反射异常等可提示神经系统受累的表现多不典型,但发生率明显高于普通组,高血压、高血糖、EV71感染检出率差异均有统计学意义(P<0.05);单因素及多因素分析显示:年龄<3岁、体温39℃以上>3天或常规退热效果不好、精神萎靡、嗜睡、易惊、惊厥、难以解释的烦躁不安、肢体抖动或震颤或肌阵挛、持续高血压、神经反射异常、EV71感染、白细胞>15×10~9/L且中性粒升高、血糖>9 mmol/L等13项指标是手足口病重症化的独立危险因素。结论年龄<3岁、体温39℃>3天或常规退热效果不好、精神萎靡、嗜睡、易惊、惊厥、难以解释的烦躁不安、肢体抖动或震颤或肌阵挛、血压持续增高、神经反射异常、EV71感染、白细胞>15×10~9/L且中性粒升高、血糖>9 mmol/L为手足口病重症化的早期预警指标,具有早期识别重症手足口病的作用。Objective Exploring early warning indicators to provide scientific bases for early identification and clinical treatments.MethodsRetrospective analysis was performed to analyze the clinical data of87children with severe hand-foot-mouth disease,and univariate and multivariateanalysis was performed too.Results Compared with general group,children(83.91%)younger than3years got severe hand-foot-mouth disease,they were often sustained high fever or their high fever was too difficult to drop,the early symptoms of vomiting,malaise,sleepiness,easily startled,convulsions,unexplained irritability,limb shaking or tremor or myoclonus,gravis,abnormal neural reflex,which may indicated nervous system be involvedwere atypical,but the incidence was significantly higher than the general group,sustained hypertension,high blood glucose and the detectionrate of EV71were higher than the general group too.Univariate and multivariate analysis showed that age younger than3years,temperature39℃lasted over three days or high fever was difficult to drop,malaise,sleepiness,easily startled,convulsions,unexplained irritability,limb shaking ortremor or myoclonus,gravis,abnormal neural reflex,sustained hypertension,high blood glucose,infected EV71,WBC>15×109/L and neutrophils increased,blood glucose>9mmol/L,etc.13indicators were independented relevant factors trending to seriousness,and played an important role inearly warning.Conclusion Age younger than3years,temperature39℃lasted over three days or high fever was difficult to drop,malaise,sleepiness,easily startled,convulsions,unexplained irritability,limb shaking or tremor or myoclonus,gravis,abnormal neural reflex,sustained hypertension,infected EV71,WBC>15×109/L and neutrophils increased,blood glucose>9mmol/L,were the early warning indicators,it is important forearly identifying severe Hand-foot-mouth disease.

关 键 词：儿童 手足口病 重症化 临床特征 危险因素 早期预警指标 

分 类 号：R725.1[医药卫生—儿科]