需机械通气的危重症手足口病患儿临床特点及预后因素分析

Clinical characteristics and prognostic factors of children with critical hand-footmouth disease treated with mechanical ventilation

摘要:

目的 分析需机械通气的危重症手足口病患儿的临床特点,探讨其预后不良的危险因素。方法 收集2012 年4 月至2013 年9 月因危重症手足口病入住儿科重症监护室且需机械通气的63 例患儿的临床资料进行回顾性分析。结果 63 例患儿中,男43 例,女20 例;平均年龄25±18 个月,其中<3 岁者占81%;4 例死亡病例均<3 岁。死亡患儿平均年龄(8±3 个月 )显著低于痊愈患儿(25±18 个月)(P<0.05)。四肢循环不良至肘膝关节以上、肺水肿累及≥ 2/3 肺野及肺出血均与死亡密切相关联(P<0.01)。死亡患儿外周血白细胞计数[(24±11)×10,⁹/L]、血乳酸(6.6±1.8 mmol/L)、血糖(16.4±2.5 mmol/L)与痊愈患儿外周血白细胞计数[(12±5)×10,⁹/L]、血乳酸(3.6±1.7 mmol/L)、血糖(10.0±3.0 mmol/L)比较,差异均有统计学意义(P<0.01)。危重病例评分<90 分者死亡风险显著增高(P<0.01)。结论 危重症手足口病以3 岁以下儿童为主。当患儿出现四肢循环不良至肘膝关节以上、肺水肿累及≥ 2/3 肺野或肺出血时再予治疗,死亡风险极大;外周血白细胞计数、血乳酸、血糖显著升高是预后不良的指标。危重病例评分与预后不良相关联。

Abstract:

Objective To investigate the clinical characteristics of children with critical hand-foot-mouth disease (HFMD) who were treated with mechanical ventilation and to explore the risk factors for poor prognosis. Methods The clinical data of 63 children with critical HFMD who were admitted to the pediatric intensive care unit between April 2012 and September 2013 and needed mechanical ventilation were retrospectively analyzed. Results Among the 63 children, 43 were boys and 20 were girls, and their mean age was 25±18 months, with 81% under 3 years old. The four death cases were all under three years old. Compared with the cured cases, the death cases had a significantly lower mean age (8±3 months vs 25±18 months; P<0.05). Poor peripheral circulation above the elbow or knee joint, pulmonary edema involving at least two thirds of the lung field, and pulmonary hemorrhage were all closely related to death (P<0.01). The death cases and cured cases had significantly different peripheral white blood cell counts, blood lactic acid, and blood glucose (24±11×10,⁹/L vs 12±5×10,⁹/L; 6.6±1.8 mmol/L vs 3.6±1.7 mmol/L; 16.4±2.5 mmol/L vs 10.0±3.0 mmol/L). The cases with critical illness score <90 had a significantly higher death risk (P<0.01). Conclusions Children with critical HFMD are mainly under 3 years old. The children face extremely high risk of death when they suffer from poor peripheral circulation above the elbow or knee joint, pulmonary edema involving at least two thirds of the lung field, and pulmonary hemorrhage. Significant increases in peripheral white blood cell counts, blood lactic acid, and blood glucose are risk factors for poor prognosis. Critical illness score is also related to poor prognosis.