严重手足口病并发心肺衰竭的危险因素分析

Analysis of risk factors of severe hand, foot, and mouth disease complicated with cardiopulmonary failure

目的探讨严重手足口病(HFMD)并发心肺衰竭的危险因素。方法回顾分析2011年12月至2016年12月收治的179例严重HFMD患儿的临床资料,依据患儿是否并发心肺衰竭分为心肺衰竭组33例、不伴有心肺衰竭146例。采用单因素分析和多因素logistic回归分析重症HFMD合并心肺衰竭的危险因素。结果单因素分析显示,性别、震颤、意识障碍、呼吸节律不齐、四肢无力、心率过慢、血压高、外周循环障碍、外周血白细胞计数、咽反射、频繁呕吐、脑脊液白细胞计数异常、脑钠肽(BNP)增加、EV-71感染、S100β蛋白增加、神经元特异性烯醇化酶增加、肌钙蛋白增加等存在显著性差异。多因素logistic回归分析显示,频繁呕吐、外周循环障碍、肠道病毒EV-71感染、呼吸节律不齐、BNP水平升高是严重HFMD合并心肺衰竭的5个独立危险因素。结论频繁呕吐、循环障碍、EV-71感染、呼吸节律不齐、BNP水平升高预示着严重HFMD患儿可能并发心肺功能衰竭。

Objective To explore the risk factors of severe hand,foot,and mouth disease(HFMD)complicated with cardiopulmonary failure.Methods The clinical data of 179 children with severe HFMD admitted from December 2011 to December 2016 were retrospectively analyzed.According to whether the children were complicated with cardiopulmonary failure,they were divided into cardiopulmonary failure group(33 cases)and non-cardiopulmonary failure group(146 cases).Univariate analysis and multivariate logistic regression analysis were used to analyze the risk factors for severe HFMD with cardiopulmonary failure.Results Univariate analysis revealed that there were significant differences between two groups in sex composition,tremor,disturbance of consciousness,irregular respiratory rhythm,limb weakness,slow heart rate,high blood pressure,peripheral circulation disorders,peripheral blood leukocyte count,pharyngeal reflex,frequent vomiting,abnormal cerebrospinal fluid leukocyte count,increased brain natriuretic peptide(BNP)levels,EV-71 infection,increased levels of S100 beta protein,neuronspecific enolase and troponin.Multivariate logistic regression analysis showed that frequent vomiting,peripheral circulation disorder,enterovirus EV-71 infection,irregular respiratory rhythm,and elevated BNP levels were five independent risk factors of severe HFMD with cardiopulmonary failure.Conclusions Frequent vomiting,circulatory disturbances,EV-71 infection,respiratory rhythm dysfunction,and elevated BNP levels are indicative of severe HFMD complicated with cardiopulmonary failure.