儿童危重型手足口病死亡的危险因素分析

目的 探讨儿童危重型手足口病死亡的危险因素。方法 以2010 年5 月至2012 年9 月监护室住院治疗的164 例危重型手足口病患儿为研究对象，根据预后分为死亡组（33 例）和存活组（131 例）。比较两组在基本情况、临床症状、体征、辅助检查方面的差异；采用非条件logistic 回归分析死亡的危险因素。结果 死亡组和存活组在不典型皮疹、持续高热（≥ 3 d）、呼吸困难、肺出血、心率增快、血压异常、冷汗、毛细血管再充盈时间>3 s、频繁抽搐发生率及血糖、血清肌酸激酶同工酶、血清乳酸水平方面存在明显差异（P<0.05）。多因素logistic 回归分析显示：肺出血（OR=9.466，95%CI：1.786~21.256）、血压异常（OR=5.224，95%CI：1.012~28.985）、血清乳酸增高（OR=2.154，95%CI：1.020~8.253）是危重型手足口病死亡的独立危险因素。结论 肺出血、血压异常、血清乳酸增高是危重症手足口病患儿死亡的主要危险因素。

Risk factors for death in children with severe hand, foot and mouth disease

Objective To study the death risk factors in children with severe hand, foot and mouth disease (HFMD). Methods A total of 164 children with severe HFMD between May 2010 and September 2012 were recruited and classified into death and survival groups according to their prognosis. The differences in general information, clinical signs and symptoms and laboratory examinations were compared between the two groups. The multivariate logistic regression analysis was used to identify death risk factors in children with severe HFMD. Results There were significant differences in the incidences of atypical rash, persistent fever, dyspnea, pulmonary hemorrhage, heart rate increase, blood pressure abnormalities, cold sweat, capillary refill time>3 seconds and frequent seizures, and blood glucose, serum creatine kinase and serum lactate levels between the death and the survival groups (P<0.05). The multivariate logistic regression analysis showed three independent death risk factors for children with severe HFMD: pulmonary hemorrhage (OR=9.466, 95%CI: 1.786-21.256), abnormal blood pressure (OR=5.224, 95%CI: 1.012-28.985) and elevated serum lactate level (OR=2.154, 95%CI: 1.020-8.253). Conclusions Pulmonary hemorrhage, abnormal blood pressure and elevated serum lactate are major death risk factors for children with severe HFMD.