广西重症手足口病患儿接受重症监护及出现死亡的危险特征分析  

Analysis of risk characteristics related to ICU and death in children with severe HFMD in Guangxi

作　　者：蓝淇元 居昱[2] 潘沛江 郑志刚 卢振伟 冯军坛[5] 彭远军 廖艳研 王海龙 周丽娟 梁浩 陈敏玫[2] 叶力 LAN Qiyuan;JU Yu;PAN Peijiang;ZHENG Zhigang;LU Zhenwei;FENG Juntan;PENG Yuanjun;LIAO Yanyan;WANG Hailong;ZHOU Lijuan;LIANG Hao;CHEN Minmei;YE Li(Guangxi Key Laboratory of AIDS Prevention and Treatment,School of Public Health,Guangxi Medical University,Nanning 530021,China;Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention,Nanning 530028,China;ChinaASEAN Joint Laboratory of Emerging Infectious Disease,Life Sciences Institute of Guangxi Medical University,Nanning 530021,China;Department of Epidemiology,School of Public Health and Management,Guangxi University of Chinese Medicine,Nanning 530200,China;Department of Pediatric Neurology,Maternity and Child Health Care Hospital of Guangxi Zhuang Autonomous Region,Nanning 530000,China)

机构地区：[1]广西医科大学公共卫生学院广西艾滋病防治研究重点实验室,南宁530021 [2]广西壮族自治区疾病预防控制中心,南宁530028 [3]广西医科大学生命科学研究院中国〔广西〕—东盟新发传染病联合实验室,南宁530021 [4]广西中医药大学公共卫生与管理学院流行病学教研室,南宁530200 [5]广西壮族自治区妇幼保健院儿童神经内科,南宁530000

出　　处：《广西医科大学学报》2024年第7期1088-1093,共6页Journal of Guangxi Medical University

基　　金：广西科技计划项目(No.桂科AD23026283);广西自然科学基金资助项目(No.2017GXNSFAA198369)。

摘　　要：目的:分析重症手足口病(HFMD)患儿在不同临床症状和体征下,进入重症监护室(ICU)及死亡的风险,为重症HFMD患儿接受重症监护与不同临床转归的危险体征识别提供参考。方法:在2014-2018年间,通过现场调查方法,对广西各县(市、区)重症住院的HFMD确诊患儿进行了连续的个案调查;采用Epidata软件对调查资料进行双录入;使用二分类logistic回归分析,比较重症HFMD患儿不同的临床症状和体征与其死亡或被收入ICU的风险(比值比,OR),明确哪些临床症状体征导致患儿更可能进入ICU及更容易死亡。结果:2014—2018年共调查广西各县(市、区)重症HFMD病例1 500例,男女性别比例为1.78∶1;发病年龄中位数为1.85岁(0~11岁)。与未出现这些症状的患儿相比,共济失调、谵妄、口唇紫绀、面色苍灰、嗜睡、无力麻痹、肢体抖动、易惊是患儿进入ICU的危险症状体征(OR分别为4.924、4.515、2.781、2.750、2.311、2.162、2.139、1.361)。血性泡沫痰、呼吸浅促、面色苍灰、口唇紫绀、呕吐是预示死亡风险增加的危险症状(OR分别为19.045、5.438、3.175、3.031、2.621)。结论:重症HFMD患儿如出现共济失调、谵妄、口唇紫绀等症状,其病情进一步发展为危重症的概率更高,并需接受重症监护治疗;如出现血性泡沫痰、呼吸浅促、面色苍灰、口唇紫绀、呕吐等症状时,应重点关注病情是否恶化而导致死亡。Objective:To analyze the risk related to intensive care units(ICU)and death in children with severe hand,foot and mouth disease(HFMD)with different clinical symptoms and signs,so as to provide a reference for the identification of risk signs and various clinical outcomes in children with severe HFMD.Methods:Between 2014 and 2018,a continuous case survey was conducted on severe HFMD children of hospitalization in various counties(cities and districts)of Guangxi through on-site investigation.Epidata software was used to double input the survey data.Binary logistic regression was used to compare the odds ratio(OR)of different clinical symp-toms and signs with death and ICU admission in children with severe HFMD,and to determine which clinical symptoms and signs made children more likely to die and be admitted to ICU.Results:A total of 1,500 severe HFMD cases were investigated in various counties(cities and districts)of Guangxi from 2014 to 2018,with a male to female ratio of 1.78:1.The median age of onset was 1.85 years(range:0-11 years).Compared with as-ymptomatic children,ataxia,delirium,cyanosis,gray complexion,lethargy,weakness and paralysis,limb shak-ing,and easy to startle were risk factors of children admitted to ICU(OR=4.924,4.515,2.781,2.750,2.311,2.162,2.139,and 1.361,respectively).Bloody foaming sputum,shallow shortness of breath,pale complexion,cy-anosis of lips and vomiting were the risk symptoms of death(OR=19.045,5.438,3.175,3.031,2.621,respective-ly).Conclusion:Children with severe HFMD who have symptoms such as ataxia,delirium,and cyanosis of lips have a higher probability of further developing into critical illness and receiving intensive care.When the symp-toms such as bloody frothy sputum,shallow shortness of breath,gray complexion,cyanosis of lips,and vomiting occur,attention should be paid to whether the condition worsens and leads to death.

关 键 词：重症手足口病 危险因素 重症监护室 死亡 

分 类 号：R725.1[医药卫生—儿科]