重症手足口病患儿合并心肺功能衰竭的危险因素及治疗体会

目的：探讨重症手足口病（HFMD）患儿合并心肺功能衰竭的危险因素及治疗体会。方法：统计分析2011年3～8月198例重症HFMD患儿的临床资料，通过单因素分析及logistic回归分析调查重症HFMD患儿合并心肺功能衰竭的危险因素并探讨丙种球蛋白联合地塞米松及利巴韦林治疗的有效性。结果：单因素分析显示，与未合并心肺功能衰竭组比较，合并心肺功能衰竭组患儿的意识障碍、呼吸急促、血流动力学改变、肌钙蛋白增高和EV71感染比例显著增加，差异有统计学意义（P<0.05）。Logistic回归分析表明，呼吸急促、血流动力学改变、EV71感染为进展为心肺功能衰竭的主要危险因素。与地塞米松+利巴韦林二联治疗比较，丙种球蛋白+地塞米松+利巴韦林三联联合治疗更能有效阻止重症HFMD患儿血流动力学的改变（P<0.01）。丙种球蛋白+地塞米松+利巴韦林三联治疗未合并心肺功能衰竭组的疗效明显好于合并心肺功能衰竭组（P<0.01）。结论：重症HFMD合并心肺功能衰竭的主要危险因素包括呼吸急促、血流动力学改变及EV71感染。早期给予丙种球蛋白+地塞米松+利巴韦林联合治疗可以减少心肺功能衰竭的发生。

Risk factors of heart and lung failure in children with severe hand, foot and mouth disease and treatment experience

Objective To study risk factors for severe hand,foot and mouth disease(HFMD) complicated by heart and lung failure and treatment experience. Methods A total of 198 children with severe HFMD between March and August in 2011 were enrolled.Univariate analysis and logistic regression model were used to analyze the risk factors severe HFMD complicated by heart and lung failure.The effects of combination therapy with immunoglobulin+dexamethasone+ribavirin were observed. Results Univariate analysis indicated that HFMD patients with heart and lung failure had higher proportions of consciousness,tachypnoea,abnormal hemodynamics,increased troponin and EV71 infection than HFMD patients without heart and lung failure(P<0.05).Multivariate logistic regression analysis indicated that tachypnoea,abnormal hemodynamics and EV71 infection were the main risk factors for heart and lung failure.Compared with combination therapy with dexamethasone+ribavirin,combination therapy with immunoglobulin+dexamethasone+ribavirin was more effective for preventing hemodynamic changes in children with severe HFMD(P<0.01).Compared with HFMD patients with heart and lung failure,the effect of the combination therapy with immunoglobulin+dexamethasone+ribavirin was better in HFMD patients without heart and lung failure(P<0.01). Conclusions The main risk factors for heart and lung failure in children with severe HFMD include tachypnoea,abnormal hemodynamics and EV71 infection.Early combination therapy with immunoglobulin+dexamethasone+ribavirin can reduce the incidence of heart and lung failure in children with severe HFMD.