儿童过敏性紫癜的临床特征与护理

目的探讨儿童过敏性紫癜(henoch-schnlein purpura,HSP)的临床特征,寻找与之对应的护理对策。方法回顾性分析2011年1-12月在上海交通大学附属儿童医院治疗的221例HSP患儿的发病特点、临床表现及肾损害原因。结果儿童HSP患儿发病年龄2～14岁,平均(7.02±2.7)岁,71.3%于冬春季节发病,79.6%患儿发病前有明确诱因。以呼吸道感染为主(72.8%),其中以胃肠道症状首发(21.3%)易发生误诊;胃肠道及关节受累发生率是62.4%和91.0%;所有患儿均有典型紫癜,主要分布于双下肢(98.6%);76.3%的紫癜于1个月内消退,而紫癜性肾炎发生率为38.9%,以皮肤紫癜为首发与非以皮肤紫癜为首发的HSP患儿的肾损害发生率分别为33.1%、48.2%,两者比较差异有统计学意义(χ2=5.044,P<0.05);临床类型以血尿和(或)蛋白尿(1～2级)最常见(62.8%),病理类型ISKDC分级以Ⅰ～Ⅲ级为主(94.1%),针对患儿的临床特征采取相应的护理对策取得满意的效果。结论 HSP为儿童常见病,以消化道症状首发时易误诊,也较严重;是否有紫癜性肾炎决定预后。不同临床表现的紫癜患儿予以个性化的护理,有利于患儿早日康复。

Clinical Features and Nursing Strategies of Henoch-Schnlein Purpura in Children

Objective To investigate the clinical features of children with henoch-schnlein purpura （HSP）, and to find the corresponding nursing strategies. Methods From January 2011 to December 2011 ,the clinical features,clinical manifestations and causes of renal damage in 221 children with HSP in the hospital were analyzed retrospectively. Results Children developed HSP at the age of 2 to 14, with a mean of （7.02±2.7） ;71.3% of the disease occurred in winter and spring and 79.6% of the children had a clear incentivebefore the onset;upper respiratory tract infection （72.8;） was the major cause and the gastroin- testinal symptoms were prone to misdiagnosis （21. 3%）. The incidences of gastrointestinal and joint involvement were 62. 4% and 91. 0;, respectively. All of the HSP children had typical purpura in the lower limbs （98.6%）. 76.3% of the purpura subsided within a month and the incidence of purpura nephritis was 38.9%. The renal damage rates of skin purpura onset and non skin purpura onset in children were 33.1% ,48.2% ,respectively, and the difference had statistically significance （2= 5. 044, P;0.05）. The most common clinical type was hematuria and （or） proteinuria （1 to 2） ,accounting for 62.8%. The pathological changes of ISKDC were graded by I - III level （94.1%）. According to the clinical features of children,nursing measures may achieve a satisfactory effect. Conclusion HSP is a common childhood disease. The onset of gastrointestinal symptoms is serious and prone to misdiagnosis. Its＇ purpura nephritis that decides the prognosis. Children with different clinical manifestations of purpura should be treated with personalized care to ensure their speedy recovery.