小儿手足口病疾病严重程度评分法的应用效果评价

Application of the severity score of hand foot and mouth disease in children

目的 制定小儿手足口病疾病严重程度评分法,指导临床医护人员早期识别小儿手足口病危重病例,进行早期干预,提高抢救成功率,降低后遗症发生率和死亡率.方法 以PCIS为基础,结合手足口病重症患儿常见的高热和神经系统损害症状,自行设计了“小儿手足口病疾病严重程度评分法”.通过回顾性分析2008年4月至2010年11月病例（A组,88例）的资料,评估了该评分法的效度、可信度.并将该评分法前瞻性地应用于201 1年5月至2013年10月所有收治的重症手足口病病例（B组,118例）,根据评分结果给予相对应的治疗和监护措施.最后将前3年（A组）与后3年（B组）患儿的预后情况进行比较.结果 评分法的分值与临床患儿实际病情严重程度一致性较好.AB 2组的基线资料比较差异无统计学意义,而2组病例在神经系统后遗症发生率和病死率等方面经x2检验,差异具有统计学意义.结论 “小儿手足口病疾病严重程度评分法”能较好地评估手足口病重症患儿的病情危重程度.临床早期应用该评分法能较客观地评估手足口病患儿,以便及时发现危重症病例,并给予相应的治疗与监护措施,对于提高手足口病危重症患儿的抢救成功率,减少神经系统后遗症发生率和降低死亡率具有一定的临床实用价值,值得在儿科临床推广应用.

Objective To develop the severity score of pediatric hand foot and mouth disease （HFMD）,guide health care providers in the early detection and intervention of critical ill cases,in order to improve the survival rate and reduce the incidence of complications and mortality.Methods Based on PCIS,the severity score of HFMD in children was designed by adding fever and nervous system damage symptoms,which was the common symptoms of severe cases.The data of the cases who admitted in April 2008 to November 2010 （group A,88 cases） was retrospectively analyzed to evaluate the validity and credibility of the score.The score were prospectively applied to all of the HFMD cases who admitted from May 2011 to October 2013（group B,118 cases）,delivering corresponding treatment and care measures based on scoring result as well.At last the outcome of the two groups was compared.Results It exhibited quite good consistency between the scores and the clinical condition of patients with HFMD.The general information of two groups was not significantly different,but the survival rate,the incidence of neurological sequel and the mortality between two groups were significantly different by x2 test.Conclusions The score can objectively and accurately assess the severity of HFMD in children.Clinical application of this scoring method to assess the children with HFMD can identify critical ill cases as early as possible.Corresponding intervention delivering in time may improve the outcome.It is proved to have positive clinical value to increase the survival rate,decrease the incidence of neurological sequel and the mortality of critical ill HFMD cases,and is worthy of clinical application in pediatric department.