重症手足口病患儿危险因素的回顾性临床分析

Retrospective Clinical Analysis of Risk Factors of Children with Severe Hand,Foot and Mouth Disease

目的探讨轻症和重症手足口病患儿的临床特征及高危因素的差异,分析儿童重症手足口病的早期识别因素。方法回顾性分析2012年1月至2016年7月在辽宁盘锦辽河油田总医院住院的246例手足口病患儿的临床资料,其中普通型手足口病患儿185例,重症型手足口病患儿61例,比较两组患儿的临床特征及高危因素的差异,采用Logistic回归模型筛选出重症手足口病的高危因素。结果普通组病例与重症组病例在发病年龄、居住地、体温、热程、精神状态、神经反射症状、皮疹性质、呕吐、口腔溃疡、胸片及实验室相关检测指标方面存在差异(P<0.05)。体温>39℃、嗜睡、精神反射异常、皮疹不典型、呕吐、血压升高、胸片异常、空腹血糖>9 mmol/L、EV71感染是手足口病重症化的独立危险因素。结论临床要高度重视精神状态差、呕吐、皮疹不典型、神经反射和胸片异常、伴血压和空腹血糖升高及EV71感染的高热手足口病患儿,这些异常指标的出现提示患儿有恶化的风险。

Objective To investigate the difference in clinical features and high risk factors of children with mild and severe hand,foot and mouth disease （HFMD） and analyze early recognition factors of the disease.Methods Retrospective analysis was conducted to analyze the clinical data of 246 inpatients with mild （n=185） and severe （n=61） HFMD from January 2012 to July 2016.Clinical features and high risk factors were compared between two groups.Logistic regression method was applied to investigate the high risk factors of severe HFMD.Results Indicators of onset age,place of residence,body temperature,fever process,mental state,symptoms of nervous reflex,rash nature,vomiting,mouth ulcer,chest X-ray and laboratory related tests were different between mild cases and severe cases of HFMD（P〈0.05）.High body temperature（〉39 ℃）,Hypersomnia,abnormal mental reflex,atypical rash,vomiting,elevation of blood pressure（BP）,abnormal chest X-ray manifestation,and fasting plasma glucose（FPG）（〉9） mmol/L,EV71 infection were identified as the independent risk factors of severe HFMD.Conclusion More attention should be paid to children with high fever（〉39 ℃） and HFMD with clinical symptoms such as abnormal mental state,vomiting,atypical rash,abnormal nervous reflex and chest X-ray manifestation,elevation of BP and FPG,and EV71 infection,for these symptoms indicate the children with HFMD are at risk for deteriorating.