CAJ | 학술논문

目的了解手足口病(HFMD)死亡患者的临床特征及早期识别和判断HFMD死亡发生的预警指标.方法收集2009-2011年山东省HFMD死亡病例41例作为病例组；根据1∶3的比例选取与死亡病例性别、籍贯、就诊医院等级相同的重症HFMD患者作为对照组,共123例.调查患儿的一般情况、诊疗情况、既往病史、临床症状及体征等信息,应用条件logistic回归分析HFMD患儿死亡发生的预警指标.结果病例组出现神经系统、消化系统、循环系统、呼吸系统症状的患儿比例依次为90.2％(37/41)、58.5％ (24/41)、53.7％(22/41)、90.2％ (37/41)；对照组依次为44.7％(55/123)、13.8％(17/123)、10.6％ (13/123)、12.2％(15/123),两组之间差异有统计学意义(x2值分别为25.881、32.791、34.011、86.505,P值均＜0.05).病例组中,有37例患儿出现神经源性肺水肿、26例出现脑炎、15例出现呼吸循环衰竭、7例出现肺出血、4例出现多器官功能衰竭、4例出现心肌炎、1例出现脑疝.经多因素logistic回归分析发现,HFMD死亡发生的预警指标有颈抵抗[病例组:34.1％(14/41),对照组:4.1％ (5/123)；OR=7.145,95％ CI:1.748～ 29.204]、呕吐[病例组:58.5％ (24/41),对照组:13.8％(17/123)；OR=5.632,95％ CI:1.793 ～ 17.685]和心率加快[病例组:53.7％(22/41),对照组:10.6％ (14/123)；OR=6.370,95％CI:1.517 ～26.743].结论在临床治疗和护理过程中,对出现颈抵抗、呕吐和心率加快的HFMD重症患儿应及时进行相关干预,减少死亡病例的出现.
목적 료해수족구병(HFMD)사망환자적림상특정급조기식별화판단HFMD사망발생적예경지표.방법 수집2009-2011년산동성HFMD사망병례41례작위병례조；근거1∶3적비례선취여사망병례성별、적관、취진의원등급상동적중증HFMD환자작위대조조,공123례.조사환인적일반정황、진료정황、기왕병사、림상증상급체정등신식,응용조건logistic회귀분석HFMD환인사망발생적예경지표.결과 병례조출현신경계통、소화계통、순배계통、호흡계통증상적환인비례의차위90.2％(37/41)、58.5％ (24/41)、53.7％(22/41)、90.2％ (37/41)；대조조의차위44.7％(55/123)、13.8％(17/123)、10.6％ (13/123)、12.2％(15/123),량조지간차이유통계학의의(x2치분별위25.881、32.791、34.011、86.505,P치균＜0.05).병례조중,유37례환인출현신경원성폐수종、26례출현뇌염、15례출현호흡순배쇠갈、7례출현폐출혈、4례출현다기관공능쇠갈、4례출현심기염、1례출현뇌산.경다인소logistic회귀분석발현,HFMD사망발생적예경지표유경저항[병례조:34.1％(14/41),대조조:4.1％ (5/123)；OR=7.145,95％ CI:1.748～ 29.204]、구토[병례조:58.5％ (24/41),대조조:13.8％(17/123)；OR=5.632,95％ CI:1.793 ～ 17.685]화심솔가쾌[병례조:53.7％(22/41),대조조:10.6％ (14/123)；OR=6.370,95％CI:1.517 ～26.743].결론 재림상치료화호리과정중,대출현경저항、구토화심솔가쾌적HFMD중증환인응급시진행상관간예,감소사망병례적출현.
Objective To understand the clinical features of death from hand,foot and mouth disease (HFMD) and to explore the early warning index of HFMD death.Methods A total of 41 HFMD death cases were collected as case group in Shandong province between 2009 and 2011,and another 123 serious HFMD cases were selected as control group according to the similar gender,place of origin and hospital level,with the ratio at 1 ∶ 3.We investigated the general situation,clinical treatment,past medical history,clinical symptoms and signs of the ill children,and applied the conditional logistic regression to explore early warning index of HFMD death.Results The rate of patients who had symptoms in nervous system,digestive system,circulatory system and respiratory system were separately 90.2 ％ (37/41),58.5 ％(24/41),53.7％ (22/41) and 90.2％ (37/41) in case group; and the proportions were 44.7％ (55/123),13.8％ (17/123),10.6％ (13/123) and 12.2％ (15/123) respectively in control group.The difference between the two groups showed statistical significance (x2 =25.881,32.791,34.011,86.505,P ＜ 0.05).In case group,37 patients had neurogenic pulmonary edema,26 patients got encephalitis,15 patients had respiratory and circulatory failure,7 patients got pulmonary hemorrhage,4 patients had multiple organ failure,4 patients got myocarditis and 1 patient had cerebral hernia.According to multi-factor logistic regression analysis,the early warning indicators of HFMD death included neck resistance (case group:34.1％ (14/41),control group:4.1％ (5/123); OR =7.145,95％ CI:1.748-29.204),vomiting (case group:58.5％ (24/41),control group:13.8％ (17/123) ; OR =5.632,95％ CI:1.793-17.685)and increase of heart rate (case group:53.7％ (22/41),control group:10.6％ (14/123),OR =6.370,95 ％ CI:1.517-26.743).Conclusion In the process of clinical treatment and care,we should interfere the serious HFMD patients with neck resistance,vomiting and increase of heart rate,and thereby reduce the death from HFMD.