EV71型手足口病病情进展的危险因素研究及其临床护理

The risk factors of enterovirus 71 infected hand-foot-mouth disease and its clinical care

目的比较病情进展中各型手足口患儿的临床特征的差异,探求重型特别是危重型手足口患儿的高危因素,细化各型手足口患儿的临床护理。方法回顾性分析2013年1月至2014年6月收治的263例EV71手足口患儿临床资料,对比普通型、重型、危重型三组病例的临床特征,采用Logistic回归模型探求重型病例与危重型病例的典型危险因素。结果普通病例与重病例在诊断时间、总热程、不典型皮疹、抽搐、颈抗、眼球震颤、呕吐、心动过速、呼吸急促、血压升高、随机血糖、外周血白细胞、CRP、IgG、IgA、胸片进展渗出性病变、MRI异常方面差异存在统计学意义(P<0.05);危重型手足口患儿在颈抗、下肢无力或瘫痪、血压等方面高于重型患儿(P<0.05);Logistic模型显示总热程、不典型皮疹、心动过速、抽搐、血压升高、随机血糖、肺部进展渗出性病变、MRI异常因素是重型手足口患儿的独立危险因素(P<0.05);不典型皮疹、颈抵抗、眼球震颤、血压升高、随机血糖、肺部进展渗出性改变是危重型手足口患儿的独立危险因素(P<0.05)。结论对于EV71患儿,临床要高度关注皮疹不典型、异常神经系统症状,且胸片、血压、血糖异常的患儿,这些异常指标提示患儿病情有进展趋势,及早给予针对性护理,以阻止疾病的恶化,降低患儿的病死率。

Objective To compare the clinical features of children with enterovirus 71 infected hand-foot- mouth disease （HFMD） during disease progression, explore the risk factors of heavy HFMD, especially in critically ill children, and refine the clinical care for various types of the disease. Methods Clinical data of 263 children with EV71 infected HFMD admitted from January 2013 to June 2014 were retrospectively ana- lyzed; the clinical features were compared between normal cases vs severe cases, and severe cases vs critical cases. The typical risk factors of heavy cases and severe cases were evaluated with Logistic regression mod- el. Results Obvious differences existed between normal cases and severe cases in the time of diagnosis, du- ration of fever, atypical rashes, convulsions, nuchal vigidity, nystagmus, vomiting, tachycardia, shortness of breath, high blood pressure, random blood glucose, peripheral blood leukocyte, CRP, IgG, IgA, pro- gressive exudative lesions in chest radiograph and abnormal MRI （P〈0.05） ; Critical cases were more seri- ous in terms of neck resistance, nystagmus, lower limb weakness or paralysis, increased blood pressure, a- typical rashes, convulsions, tachycardia, shortness of breath, random blood sugar, pulmonary progressive exudative lesions and abnormal MRI than severe cases （P〈0.05）. Logistic model results showed that the duration of fever, atypical rashes, tachycardia, convulsions, blood pressure, random blood sugar, pulmona- ry progressive exudative lesions and abnormal MRI were independent risk factors of severe HFMD （P〈0. 05）, while atypical rashes, cervical resistance, nystagmus, increased blood pressure, random blood sug-at, and progressive exudative lesions in lung were independent risk factors of critical cases （P〈0.05）. Con- clusion For children with enterovirus 71 HFMD, it is necessary to pay highly attention to atypical rashes,abnormal neurological symptoms, chest radiograph, abnormal blood pressure and blood sugar, which indi- cate progressive trends, nursing staff must give corresponding intervention as early as possible, to preventthe deterioration of disease and reduce the mortality of sick children.