手足口病患儿并发脑膜脑炎的危险因素及护理

Analysis of risk factors and nursing about hand-foot-mouth disease children complicated with meningoencephalitis

目的：探讨手足口病并发脑膜脑炎的高危因素，为护士进行预见性评估、制订护理措施提供依据。方法将2010年1月—2013年6月入住儿科的998例重症倾向的手足口病（HFMD）患儿根据有无并发脑膜脑炎分为并发脑膜脑炎组和非脑膜脑炎组，从护理角度回顾分析两组在临床表现、体征、实验室检查结果之间的差异，采用单因素分析法分析并发脑膜脑炎的危险因素。结果频繁惊跳、肢体抖动、呕吐、肢体无力、持续高热、呼吸异常、循环功能障碍、外周血 WBC 计数升高及血糖升高对预测HFMD 合并脑膜脑炎均有统计学意义（P 〈0.05），其敏感度由高到低依次为：频繁惊跳（95.05%）、外周血 WBC 计数升高（90.10%）、持续高热（89.11%）、呼吸异常（77.24%）、血糖升高（63.37%）、呕吐（42.57%）、肢体抖动（12.38%）、循环障碍（6.93%）、肢体无力（6.93%）；特异度由高到低依次为循环障碍（99.87%）、肢体无力（99.75%）、肢体抖动（99.75%）、频繁惊跳（99.62%）、呕吐（91.46%）、呼吸异常（66.33%）、持续高热（65.33%）、血糖升高（47.61%）、外周血 WBC 升高（47.24%）。结论护士应加强对出现频繁惊跳、肢体抖动、呕吐、肢体无力、持续高热、呼吸异常、循环功能障碍、外周血 WBC 计数升高及血糖升高的手足口病患儿的护理观察，并制订相应的预见性护理干预措施，及时发现 HFMD 并发脑膜脑炎，从而减少其从重症向危重症发展，降低死亡率。

Objective To explore the risk factors of meningoencephalitis with hand-foot-mouth disease （HFMD） for predictive evaluating and providing evidence for nursing measures. Methods According to the presence of meningoencephalitis, 998 cases with hand-foot-mouth disease were divided into the meningoencephalitis and non meningoencephalitis group. The difference of clinical manifestations, signs and laboratory test resultsbetween two groups were discussed by retrospective analyzing from the perspective of nursing, and we used single factor analysis method to reveal the risk factors of meningoencephalitis. Results The statistical analysis showed that there was a statistical significance in using frequently myoclonicjerk,limbjitter, vomiting,limb weakness, continued highfever, abnormal breathing, circulation dysfunction, blood WBC count and elevatedblood glucoseto predict meningoencephalitis with hand-foot-mouth disease （ P 〈 0. 05 ）. The sensitivity respectively were frequently myoclonic jerk （95. 05% ）,blood WBC count （90. 10% ）,continued high fever （89. 11% ）,abnormal breathing （77. 24% ）, elevated blood glucose （63. 37% ）,vomiting （42. 57% ）, limb jitter （12. 38% ）, circulation dysfunction （ 6. 93% ） and limb weakness （ 6. 93% ）. The specificity respectively were circulation dysfunction （99. 87% ）, limb weakness （99. 75% ）, limb jitter （99. 75% ）, frequently myoclonic jerk （99. 62% ）,vomiting （91. 46% ）,abnormal breathing （66. 33% ）,continued high fever （65. 33% ）, elevated blood glucose （47. 61% ） and blood WBC count （47. 24% ）. Conclusions The nurses should strengthen the nursing observation on children with myoclonicjerk, limbjitter, vomiting, limbweakness, continued high fever, abnormal breathing, circulation dysfunction, blood WBC count and elevatedblood glucose. The corresponding nursing intervention measures are also formulated and timely finding meningoencephalitis with HFMD for reducing the developments of severe disease and the mortality.