手足口病诊疗指南危重症早期预警指标对其危重症预警价值

Value of Early Warning Indicators in Diagnosis and Treatment Guideline of Hand-foot-month Disease（HFMD） in Prewarning of Critical Illness Patients with HFMD

【目的】探讨2011年手足口病（HFMI））诊疗指南危重症早期预警指标对危重症HFMD的预警价值。【方法】采用2011年HFMD诊疗指南早期预警指标回顾性分析2009年6月至2011年5月本院收治的重症HFMD患儿438例（第一组）。然后前瞻性分析2011年6月至2013年5月本院收治的重症HFMD患儿509例（第二组）。按符合2011年HFMD诊疗指南危重症早期预警指标项目的数目把重症HFMD患儿分为4类。结合最终进展为危重症HFMD的对应例数，探讨2011年HFMD诊疗指南危重症早期预警指标的顸警价值。【结果】第一组按符合危重症早期预警指标的数目进行分类：符合一项的患儿314例，转为危重症HFMD为10例，发生率3．2％；符合两项的患儿为223例，转为危重症HFMD21例，发生率为9．4％；符合三项的患儿为101例，转为危重症HFMD48例，发生率为47．5％；符合四项的患儿为18例，转为危重症为15例，发生率为83．3％。第二组按预警指标对重症HFMD患儿进行分类：符合一项的患儿416例，转为危重症HFMD为5例，转为危重症HFMD的发生率为1．2％；符合两项的患儿为105例，转为危重症HFMD8例，发生率为7．6％；符合三项的患儿为42例，转为危重症HFMD12例，发生率为28．6％；符合四项的患儿为8例，转为危重症为7例，发生率为87．5％。符合三项时两组危重症转化发生率比较差异具有统计学意义（P〈0．05）。【结论12011年HFMD诊疗指南危重症早期预警指标可以较好的预测重症转为危重症患儿的发生，特别是符合三项的重症HFMD患儿需要高度重视，积极干预，避免伤残，提高救治率。

[Objective]To explore the value of early warning indicators in 2011 hand-foot-month disease（HFMD） diagnosis and treatment guideline in prewarning of critical illness patients with HFMD. [Methods]Totally 438 pediatric patients with HFMD（first group） in our hospital from June 2009 to May 2011 were analyzed retrospectively by using early warning indicators in 2011 HFMD diagnosis and treatment guideline. Totally 509 pediatric patients with severe HFMD（second group） in our hospital from June 2011 to May 2013 were analyzed prospectively. According to the number to early warning indicators in 2011 HFMD diagnosis and treatment guideline, all severe HFMD patients were divided into 4 groups. The corresponding case number of critical illness patients with HFMD in the end was considered comprehensively. The value of early warning indicators of critical illness in 2011 HFMD diagnosis and treat- ment guideline was discussed. [Results]According to the number to early warning indicators of critically ill HFMD, there were 314 patients with one indicator in which 10 patients converted to critically ill HFMD and the conversion rate was 3.2%, and 223 patient with 2 indicators in which 21 patients converted to critically ill HFMD and the conversion rate was 9.4, and 101 patients with 3 indicators in which 48 patients converted to critically ill HFMD and the conversion rate was 47.5%, and 18 patients with 4 indicators in which 15 patients converted to critically ill HFMD and the conversion rate was 83.3% in first group. According to the number to early warning indicators of severe HFMD, there were 416 patients with one indicator in which 5 patients converted to critically ill HFMD and the con- version rate was 1.2%, and 105 patients with 2 indicators in which 8 patients converted to critically ill HFMD and the conversion rate was 7.60%, and 42 patients with 3 indicators in which 12 patients converted to critically ill HFMD and the conversion rate was 28.6 %, and 8 patients with 4 indicators in which 7 patients converted to critically ill HFMD and the conversion rate was 87.5 % in second group. There was significant difference in conversion rate of critical illness with 3 indicators between two groups （ P 〈 0. 05 ）. [Conclusion]Early warning indicators of critically ill HFMD in 2011 HFMD diagnosis and treatment guideline can better predict the incidence of severe HFMD converting to critically ill HFMD in pediatric patients. In particular, severe HFMD patients with 3 indicators should be paid more attention and intervened actively in order to avoid disability and improve the treatment rate.