重症手足口病患儿合并心肺功能衰竭的危险因素及疗效观察

Risk factors of severe hand-foot-mouth diseased complicated with heart and lung function failure in children and the observation on the therapeutic effect

目的探讨重症手足口病患儿合并心肺功能衰竭的危险因素及治疗效果。方法 2015年5月至2016年5月开封市儿童医院重症医学科收治了重症手足口病患儿108例,随机分为二联用药组和三联用药组各54例。每组合并心肺衰竭45例,未合并心肺衰竭9例。结合患儿具体病情,采取三联或二联用药。二联用药组为喜炎平注射液+丙种球蛋白;三联用药组为喜炎平注射液+丙种球蛋白+甘露醇或米力农或多巴酚丁胺。分析患儿合并心肺功能衰竭的影响因素,观察药物治疗的临床疗效、并发症情况、病死率、平均住院时间、心肌酶恢复时间、呼吸机撤机时间。结果三联用药组治疗总有效率为100.0%(54/54),显著高于二联用药组83.3%(45/54),差异有统计学意义(P<0.05)。三联用药组并发症发生率为1.9%(1/54)、病死率为0%,显著低于二联用药组14.8%(8/54)、14.8%(8/54),差异有统计学意义(P<0.05)。三联用药组平均住院时间、心肌酶恢复时间、呼吸机撤机时间均低于二联用药组,差异有统计学意义(P<0.05)。合并心肺衰竭患儿的血流动力学改变、EV71感染、呼吸急促、意识障碍、肌钙蛋白增高所占比重显著高于未合并心肺衰竭患儿,差异有统计学意义(P<0.05)。经多因素Logistic回归分析可知,血流动力学改变、EV71感染、呼吸急促为独立危险因素。结论重症手足口病患儿合并心肺功能衰竭主要与血流动力学改变、EV71感染、呼吸急促有关,通过三联药物治疗,保证了治疗效果,延长了患者生存时间,改善了患者预后,满足了其治疗需求,值得推广。

Objective To study the risk factors of severe hand-foot-mouth diseased（ HFMD） compli-cated with heart and lung function failure in children and the therapeutic effect. Methods A total of 108 HFMD children were treated in Kaifeng Childrens Hospital from May 2015 to May 2016 ,and they were ran-domly divided into two groups： two-drug group and three-drug group, with 54 children in each. There were 45 cases with heart and lung failure and 9 cases without heart and lung failure in each group. The treatment of two-drug or three-drug was performed according to the disease condition. Xiyanping injection and gamma globulin were used in the two-drug treatment group; Xiyanping injection, gamma globulin and mannitol or milrinone or dobutamine were used in the three-drug group. Analyze the risk factors of the HFMD children complicated with heart and lung failure; observe the clinical effect, complications, mortality, average hospi-tal stay？ recovery time of myocardial enzyme 〉 and the time to withdraw respirator. Results The total effec-tive rate in three-drug group was 100. 0% （54/54） ,significantly higher than the 83. 3% （45/54） of the two- drug group, the difference being statistical（P〈0. 05）. The incidence rate of complications and mortality in three-drug group was significantly lower than that in two-drug group（P〈0. 05）. The average hospital stay, recovery time of myocardial enzyme and the time to withdraw respirator in three-drug group were all shorter than those in two-drug group（P^0. 05）. The hemodynamic change〉 EV71 infection, polypnea？ disorders of consciousness and increase of troponin were of a higher proportion in children complicated with heart-lung failure than in those without, and the difference was of statistical significance（P〈CO. 05）. Multi-factor Logistic regression analysis showed that hemodynamic change, EV71 infection and polypnea were the independent risk factors. Conclu-sion The heart-lung function failure in Children with severe HFMD is mainly related to hemodynamic change, EV71 infection and polypnea. The three-drug treatment can achieve great effect, which lengthens the survival time of patients, improves the prognosis and meets the treatment demand. Therefore it should be popularized.