危重手足口病患儿临床发病特点和有创血流动力学监测分析

Clinical Characteristics of Critically Ill Children with Hand-Foot-Mouth Disease and the Application of Invasive Hemodynamic Monitoring

目的:探讨危重手足口病患儿的临床发病特点,评价有创血流动力学监测在危重手足口病患儿临床救治过程中的应用。方法:对我院2009年1月至2011年12月PICU收治的95例危重手足口病患儿的临床资料进行回顾性分析,总结发病特点,统计危重手足口病患儿中心静脉压、连续有创动脉血压和脉搏连续心输出量(PiCCO)监测的应用趋势,并对不同监测途径相关临床应用进行比较。结果:我院PICU收治的危重手足口病患儿分别为2009年18例、2010年28例、2011年49例,总计95例。2009-2011年需呼吸机支持治疗分别为11例、19例和34例,均在50%以上。死亡病例16例,死亡病例在频繁抽搐(>3次)、昏迷、肺出血、消化道出血、尿潴留方面与存活组比较差异有统计学意义(P<0.05),其中PICU病死率2010年和2011年分别为17.8%和22.4%。中心静脉置管率由2009年的38.89%提高至2011年的93.88%;连续有创动脉血压监测率由2009年的33.33%提高至2011年的67.35%。2011年PiCCO监测5例(10.20%)。应用中心静脉压、连续有创动脉血压构成比较高,应用广泛;PiCCO监测参数相对较多,监测费用高,指导价值相对较高。结论:危重手足口病存在高发病率、高病死率和高呼吸机使用率,对有创血流动力学监测的需求高。死亡病例频繁抽搐、昏迷、肺出血、消化道出血、尿潴留发生率较高。

Objective： To discuss clinical characteristics of critically ill children with hand-foot-mouth disease （HFMD）, and to evaluate the application of invasive hemodynamic monitoring in the process of clinical treatment. Methods： From January 2009 to December 2011, ninety-five critically ill patients with HFMD were admitted to PICU in our hospital. The clinical data were retrospectively analyzed ; the characteristics were summarized ; the application trend of the central venous pressure, continuous invasive artery blood pressure and continuous cardiac output pulse monitoring were counted. The clinical data of different monitoring methods were comparatively analyzed. Results： Critical ill patients with HFMD admitted to PICU in our hospital in recent three years were eighteen, twenty-eight and forty-nine cases, respectively. The total number of cases was ninety-five. The numbers of cases needed mechanical ventilation in recent three years were eleven, nineteen and thirty-four, respectively. More than half of patients received respiratory support treatment. Sixteen patients were dead. Compared with the survival cases, the frequent hypcrspasmia （〉three times） , coma, pulmonary hemorrhage, gastrointestinal bleeding and urinary retention in the death cases were statistically different （P〈0.05）. Mortality in PICU in 2010 and 2011 were 17.8% and 22.4% , respectively. The application rate of central venous catheterization increased from 38.89% in 2009 to 93.88% in 2011. The continuous invasive arterial blood pressure monitoring rate increased from 33.33% in 2009 to 67.35% in 2011. Five eases were monitored PiCCO in 2011. Continuous invasive arterial blood pressure and central venous pressure were widely used. Many parameters of PiCCO cardiac output could be monitored, the guiding value was relative high, but the cost was expensive. Conclusions： Critical ill children with HFMD have high morbidity, high mortality and high ventilator utilization rate. The demand for invasive hemodynamic monitoring was increasing. The incidence of frequent hyperspasmia, coma, pulmonary hemorrhage, gastrointestinal bleeding and urinary retention were high in death cases.