开封地区2016年重症手足口病251例情况分析

Analysis of 251 cases of severe hand foot and mouth disease in Kaifeng in 2016

目的调查开封市儿童医院2016年儿科重症监护病房(PICU)重症手足口病(HFMD)住院儿童情况,为当地重症HFMD诊治工作提供参考。方法收集2016年1—12月开封市儿童医院PICU住院的251例HFMD患儿的临床资料进行回顾性分析。结果 HFMD患儿平均年龄为(24±13)个月,4～7个月入院患儿占84.46%(212/251);感染肠道病毒71型(enterovirus 71,EV71)患儿为78.6%(195/248),柯萨奇病毒A16型(Coxsackievirus A16,CA16)为5.6%(14/248),柯萨奇病毒B组(CVB)为52.4%(130/248);死亡病例11例,主要发生在入院前3天(8/11,72.7%),其平均年龄[(20.82±8.69)个月]与好转患儿年龄[(24.08±13.04)个月]无差异(t=1.183,P=0.259)。气管插管机械通气患儿年龄[(21.05±10.67)个月]小于无创呼吸机辅助通气患儿年龄[(25.91±14.00)个月](t=-3.015,P=0.003); PICU住院时间2周以内占84.86%(212/251)。结论 2016年开封地区重症HFMD有较高的死亡率,年龄偏小患儿病情更重,更需要气管插管机械通气呼吸支持;对入院前3天、EV71或CVB感染患儿也需加强警惕。

Objective To provide references for the local diagnosis and treatment of severe HFMD by investigating the situation of hospitalized children with severe hand-foot-mouth disease in the pediatric intensive care unit of Kaifeng children's hospital in 2016.Methods We collected the clinical data for retrospective analysis of 251 HFMD patients hospitalized in PICU of Kaifeng children's hospital from January to December 2016.Results The average age of all HFMD children was(24±13)months,and the percentage of hospitalized children from April to July was 84.46%(212/251).The percentage of children infected with enterovirus 71 was 78.6%(195/248),coxsackievirus A16 was 5.6%(14/248),and coxsackievirus B was 52.4%(130/248).Most of the 11 inpatient deaths mainly occurs in the first three days after administration(8/11,72.7%).There was no difference in the mean age between the inpatient deaths(20.82±8.69 months)and recovering inpatient(24.08±13.04 months)(t=1.183,P=0.259).The average age of children received tracheal intubation mechanical ventilation(21.05±10.67 months)was lower than the children received non-invasive ventilator assisted ventilation(25.91±14.00 months),(t=-3.015,P=0.003).84.86%of the inpatient in the PICU was within 2 weeks(212/251).Conclusions Severe hand foot and mouth disease in 2016 has a high mortality rate in Kaifeng area.Younger inpatients are more serious and require tracheal intubation for respiratory support.More attention should pay to inpatient infected with EV71 or CVB in the first three days.