基于医院信息系统的手足口病合并症及用药研究

Concomitant Disorders and Medication in Hand,Foot and Mouth Disease: an Analysis Based on the Patients' Data from Hospital Information System

目的探讨我国手足口病(HFMD)患者的合并症情况及用药规律。方法在中国中医科学院中医临床基础研究所建立的数据仓库中,选取2006年11月—2011年6月9家三级甲等综合医院医院信息系统(HIS)记录的941例第一诊断为HFMD患者的住院信息。对患者的一般信息、合并症情况进行描述性统计分析,采用频数分析法、关联分析探讨患者的用药情况。结果共625例患者记录了年龄,其中1~6岁601例(96.2%)。941例患者均记录了合并症,发生率排在前3位的合并症分别为肺炎(3.9%,37/941)、发热(1.4%,13/941)、贫血(1.3%,12/941)。720例患者记录了用药情况,使用率排在前3位的西药分别为维生素(82.8%,596/720)、氯化钾(33.2%,239/720)、地塞米松(25.6%,184/720),使用率排在前3位的中药分别为板蓝根(14.4%,104/720)、抗病毒感冒颗粒(10.1%,73/720)、咳喘宁(2.5%,18/720)。关联分析结果显示,在1类中药+1/2/3类西药的组合方式中,联合使用率排在首位的分别为板蓝根+重组人干扰素、板蓝根+匹多莫德+重组人干扰素、板蓝根+对乙酰氨基酚+匹多莫德+重组人干扰素。在常用中、西药物中,抗病毒感冒颗粒与维生素经常联合使用,板蓝根与维生素联合使用次之。结论真实世界中应将1~6岁儿童作为HFMD的重点预防人群,合并症多由感染引起,以临床常用中、西药联合使用的治疗模式最为常见,同时应注意营养支持和预防感染,清热解毒类中药与抗生素联合最为常用。

Objective To investigate the concomitant disorders and medication regularity in hand,foot and mouth disease in China. Methods From the hospital information system（ HIS） of nine tertiary grade A general hospitals in the database built by Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences,we chose the data of 941 cases who were initially diagnosed as hand, foot and mouth disease and hospitalized between November 2006 and June2011. Descriptive statistical analysis was performed to analyze the clinical data covering concomitant disorders. Frequency analysis and association analysis were carried out to investigate the medication in the patients. Results Of the 625 cases whose age was recorded in the HIS,96. 2%（ 601/625） aged 1-6 years old. All of the participants had concomitant disorders recorded in the HIS. The three most frequently occurring concomitant disorders were pneumonia [3. 9%（ 37/941） ], fever [1. 4%（ 13/941） ]and anemia [1. 3%（ 12/941） ]. The medication of 720 cases were Vecorded in the HIS. The three most commonly used western drugs were Vitamins [82. 8%（ 596/720） ], Potassium chloride [33. 2%（ 239/720） ] and Dexamethasone[25. 6%（ 184/720） ],and the three most commonly used Chinese herbal drugs were Radix isatidis [14. 4%（ 104/720） ],Anti-cold granules [10. 1%（ 73/720） ]and Kechuanning [2. 5%（ 18/720） ]. Association analysis found that,the most frequently used drug combination therapies in the combination modes of one type of Chinese herbal drug ＋ one/two/three types of western drugs were Radix isatidis ＋ Recombinant human interferon,Radix isatidis ＋ Pidotimod ＋ Recombinant human interferon,and Radix isatidis ＋ Acetaminophen ＋ Pidotimod ＋ Recombinant human interferon. In the commonly used drugs（ both Chinese herbal drugs and western drugs）,Anti-cold granules and Vitamins are often used in combination,followed by Radix isatidis and Vitamins in combination. Conclusion The prevention of HFMD in children aged 1-6 should be paid more attention. Concomitant disorders of HFMD are usually caused by infection. One type of Chinese herbal drug combined with one or more types of western drugs,specifically,one Chinese herbal drug with reducing fever and anti-virus effect ＋ one or more types of antibiotics,is the most common therapy for these patients. Meanwhile,nutrition support and infection prevention should be noticed during the treatment.