基础生命体征在判断重症手足口病患儿机械通气时机和死亡风险预测中的临床价值(1)
摘 要：目的 探讨基础生命体征在判断重症手足口病患儿机械通气时机和死亡风险预测中的临床价值。方法 回顾性分析2012年4月～2016年10月我院收治的554例重症手足口病患儿的临床资料，根据病情进展情况分为非机械通气组445例，机械通气组80例，死亡组29例，采用方差分析、直线回归、Logistic回归分析和非参数统计等方法分析患儿入院前发热天数、峰热及心率、呼吸频率、收缩压和舒张压在判断重症手足口病患儿机械通气时机和死亡风险预测中的临床价值。结果 三组患儿的入院前发热天数、HR、RR、SBP、DBP比较，差异具有统计学意义(P<0.05)；RR、SBP、DBP与机械通气相关，当RR≥63次/min或血压≥170/100 mmHg，提示需要机械通气的概率增大；机械通气时间与死亡相关，机械通气到第5天时，死亡率增加到70%以上。结论 入院前发热天数、HR、RR、SBP、DBP在预测重症手足口病机械通气时机及死亡中有临床价值，当呼吸、心率增快，血压升高时，要及早机械通气治疗，合理地缩短机械通气时间可以降低死亡率。
关键词：重症手足口病；基础生命体征；预测方程；机械通气；死亡
, http://www.100md.com
中图分类号：R725.1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.12.021
文章编号：1006-1959(2018)12-0069-05
Abstract：Objective To investigate the clinical value of basic vital signs in predicting the timing of mechanical ventilation and risk of death in children with severe hand， foot and mouth disease.Methods The clinical data of 554 children with severe hand foot and mouth disease admitted to our hospital from April 2012 to October 2016 were retrospectively analyzed.According to the progression of the disease，445 patients were included in the non-mechanical ventilation group，80 patients in the mechanical ventilation group，there were 29 patients in the death group.The analysis of variance analysis，linear regression，Logistic regression analysis and non-parametric statistics were used to analyze the pre-hospital fever days，peak fever and heart rate，respiratory frequency，systolic blood pressure，and diastolic pressure in juvenile children with severe hand foot and mouth disease.The clinical value of risk prediction.Results The number of febrile days before admission，HR，RR，SBP and DBP in the three groups were statistically significant(P<0.05)；RR，SBP，DBP were related to mechanical ventilation， when RR≥63/min or blood pressure≥170/100 mmHg，suggesting an increase in the probability of requiring mechanical ventilation；mechanical ventilation time is associated with death， and mechanical ventilation increases to more than 70% on the fifth day.Conclusion Pre-hospital fever days，HR，RR，SBP，and DBP have clinical value in predicting the timing of mechanical ventilation and death of severe hand-foot-mouth disease.When breathing，rapid heart rate，and elevated blood pressure，mechanical ventilation should be treated as soon as possible to shorten mechanically ventilation time can reduce mortality.
, 百拇医药
Key words：Severe hand foot and mouth disease；Basic vital signs；Prediction equation；Mechanical ventilation；Death
手足口病(hand foot and mouth disease，HFMD)是由肠道病毒(EV71和CoxA16为主)引起的小儿急性传染病。目前我国呈局部暴发流行趋势，我市为广西手足口病高发地区之一，每年都有一个时段暴发流行手足口病，其中有不少重症病例。重症患儿可并发脑炎、脑干脑炎、神经源性肺水肿、肺出血、急性迟缓性麻痹等，病死率高，易留下神经系统后遗症[1]。HFMD重癥病例致死原因主要是脑干脑炎及神经源性肺水肿(多由EV71感染引起)[2]。WHO《手足口病临床管理与公共卫生应对指南(2011)》指出有中枢神经系统受累的儿童，表现出自主神经系统功能失调的症状(心率增快、血压升高、呼吸急促及大汗等)，具有快速发展为心肺衰竭的危险[3]。因此，我国[4]及WHO[5]指南等都建议将基础生命体征列入HFMD重型病例的识别指征。目前，国内外关于手足口病的临床研究多数集中在流行病学分布、分子病原学、血清流行病学、临床救治、发病危险因素等方面[2，3，6-8]。有报告提示，基础生命体征异常、神经系统表现以及包括细胞因子在内的辅助检查指标异常是HFMD重型的危险因素或识别指标[9-13]。杜兴媛[14]等通过定量基础生命体征来指导临床早期识别重症手足口病。根据生命体征的改变，及早识别危重患儿，并及时使用呼吸机机械通气改善患儿的生命体征，把治疗关口前移，是目前提高危重症患儿抢救成功率、改善预后的关键。本研究通过分析我院2012年4月～2016年10月收治的554例重症HFMD患儿的临床资料，用量化的基础生命体征数据作为重症HFMD患儿机械通气时机及预测死亡风险的直接依据，不仅能早期识别HFMD重症病例，而且能准确把握机械通气时机和预测死亡风险，对于当前临床救治重症HFMD具有重要的指导意义。, http://www.100md.com(覃艺 邓燕艺 赖昌生 甘宁 马晓红 李霞 丘丽莉)
关键词：重症手足口病；基础生命体征；预测方程；机械通气；死亡
, http://www.100md.com
中图分类号：R725.1 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.12.021
文章编号：1006-1959(2018)12-0069-05
Abstract：Objective To investigate the clinical value of basic vital signs in predicting the timing of mechanical ventilation and risk of death in children with severe hand， foot and mouth disease.Methods The clinical data of 554 children with severe hand foot and mouth disease admitted to our hospital from April 2012 to October 2016 were retrospectively analyzed.According to the progression of the disease，445 patients were included in the non-mechanical ventilation group，80 patients in the mechanical ventilation group，there were 29 patients in the death group.The analysis of variance analysis，linear regression，Logistic regression analysis and non-parametric statistics were used to analyze the pre-hospital fever days，peak fever and heart rate，respiratory frequency，systolic blood pressure，and diastolic pressure in juvenile children with severe hand foot and mouth disease.The clinical value of risk prediction.Results The number of febrile days before admission，HR，RR，SBP and DBP in the three groups were statistically significant(P<0.05)；RR，SBP，DBP were related to mechanical ventilation， when RR≥63/min or blood pressure≥170/100 mmHg，suggesting an increase in the probability of requiring mechanical ventilation；mechanical ventilation time is associated with death， and mechanical ventilation increases to more than 70% on the fifth day.Conclusion Pre-hospital fever days，HR，RR，SBP，and DBP have clinical value in predicting the timing of mechanical ventilation and death of severe hand-foot-mouth disease.When breathing，rapid heart rate，and elevated blood pressure，mechanical ventilation should be treated as soon as possible to shorten mechanically ventilation time can reduce mortality.
, 百拇医药
Key words：Severe hand foot and mouth disease；Basic vital signs；Prediction equation；Mechanical ventilation；Death
手足口病(hand foot and mouth disease，HFMD)是由肠道病毒(EV71和CoxA16为主)引起的小儿急性传染病。目前我国呈局部暴发流行趋势，我市为广西手足口病高发地区之一，每年都有一个时段暴发流行手足口病，其中有不少重症病例。重症患儿可并发脑炎、脑干脑炎、神经源性肺水肿、肺出血、急性迟缓性麻痹等，病死率高，易留下神经系统后遗症[1]。HFMD重癥病例致死原因主要是脑干脑炎及神经源性肺水肿(多由EV71感染引起)[2]。WHO《手足口病临床管理与公共卫生应对指南(2011)》指出有中枢神经系统受累的儿童，表现出自主神经系统功能失调的症状(心率增快、血压升高、呼吸急促及大汗等)，具有快速发展为心肺衰竭的危险[3]。因此，我国[4]及WHO[5]指南等都建议将基础生命体征列入HFMD重型病例的识别指征。目前，国内外关于手足口病的临床研究多数集中在流行病学分布、分子病原学、血清流行病学、临床救治、发病危险因素等方面[2，3，6-8]。有报告提示，基础生命体征异常、神经系统表现以及包括细胞因子在内的辅助检查指标异常是HFMD重型的危险因素或识别指标[9-13]。杜兴媛[14]等通过定量基础生命体征来指导临床早期识别重症手足口病。根据生命体征的改变，及早识别危重患儿，并及时使用呼吸机机械通气改善患儿的生命体征，把治疗关口前移，是目前提高危重症患儿抢救成功率、改善预后的关键。本研究通过分析我院2012年4月～2016年10月收治的554例重症HFMD患儿的临床资料，用量化的基础生命体征数据作为重症HFMD患儿机械通气时机及预测死亡风险的直接依据，不仅能早期识别HFMD重症病例，而且能准确把握机械通气时机和预测死亡风险，对于当前临床救治重症HFMD具有重要的指导意义。, http://www.100md.com(覃艺 邓燕艺 赖昌生 甘宁 马晓红 李霞 丘丽莉)