【摘要】 目的探讨儿童手足口病(HFMD)重症发展为危重症的危险因素。方法通过回顾性分析2014年7月至2015年7月西安市儿童医院感染二科收治的200例HFMD患儿(重症组150例、危重症组50例)的临床资料,采用单因素及多因素非条件Logistic回归分析,比较两组患儿临床表现、辅助检查结果的差异,探讨重症HFMD进展为危重症的危险因素。结果两组患儿发病年龄3岁以下婴幼儿居多(重症组和危重症组占75%和90%),两组均以男孩为主,男女比例分别为2.26∶1和9.00∶1。肠道病毒71型是危重症手足口病感染的主要病原(占94%)。重症和危重症病例绝大多数有发热和皮疹,神经系统症状以肢体抖动、肢体无力、嗜睡、呕吐、抽搐多见,危重症病例除了上述症状外,呼吸、循环系统亦严重受累。单因素分析提示心率增快、呼吸增快、白细胞升高、血糖升高、持续高热、肢体无力、肢体抖动、精神萎靡、皮疹不典型、末梢循环不良、C-反应蛋白升高、肺部啰音、EV71阳性为重症HFMD进展为危重症的危险因素(P<0.05),而多因素非条件Logistic回归分析显示心率增快(χ~2=8.615、P<0.001)、肺部啰音(χ~2=15.498、P<0.001)、末梢循环不良(χ~2=22.153、P<0.001)为发生危重症病例的独立危险因素。结论根据对重症HFMD患者心率、末梢循环、肺部啰音的密切观察,能够对危重症的发生进行早期预警。更多还原

【Abstract】 Objective To investigate the risk factors of the severe hand, foot and mouth disease(HFMD) changing into critical several HFMD in children. Methods The clinical data of the 200 hospitalized children with HFMD in the second Department of Infectious Diseases, Xi’an Children Hospital from July 2014 to July 2015 were reviewed, retrospectively, including 150 children with severe HFMD and 50 cases with critical several HFMD. The clinical manifestations and auxiliary examination results of the two groups were compared by the Logisic regression analysis. Results Among the two groups, most children were younger than 5 years, mainly younger than 3 years(75% in several group and 90% in critical several group). The ratio of male and female in the two groups were 2.26∶1 and 9.00∶1, respectively. Most children had fever and rash. Limb trembling, limb weakness, drowsiness, vomiting, convulsion were common when children were involved with in nervous system. According to univariate analysis of Logistic regression, fast heart rate, fast breath, leukocytosis, high blood sugar, fever, limb trembling/weakness, drowsiness, atypical rash, poor peripheral circulation, improved C-reactive protein, pulmonary rales and EV71 positive were all the risk factors of HFMD.Multivariate Logistic regression analysis showed that fast heart rate(χ~2 = 8.615, P < 0.001), pulmonary rale(χ~2 = 15.498, P < 0.001), poor peripheral circulation(χ~2 = 22.153, P < 0.001) were independent risk factors for critical several cases, with significant differences. Conclusions According to the close observation of the heart rate, peripheral circulation and pulmonary rales of the patients with severe HFMD, early warning of the occurrence of critical illness could be carried out.更多还原