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目的研究重症手足口病(hand-foot-and-mouth disease,HFMD)进展为神经源性肺水肿的高危因素,为神经源性肺水肿的早期诊断及干预提供依据。方法选择2010年4月1日至2010年10月30日在石家庄市第五医院就诊的重症手足口病患者,根据是否进展为神经源性肺水肿而进行分组,选择性别和年龄作为配比因素进行1∶3的配比病例对照研究。结果两组患儿在发病-就诊时间、发病-重症时间、初诊在村级医疗机构就诊、初诊确诊手足口病、最高体温≥39℃、持续高热(体温≥38.5℃且持续时间≥3d)、肢体无力、呼吸浅快或节律不规则、肺部杂音、血压≥130mm Hg、心率≥150次/min和血氧饱和度≤91%以及外周白细胞计数>12×109/L、血糖>8.3mmol/L、肌酸激酶升高、C反应蛋白阳性的发生率等因素差异均具有显著性(P<0.05),而首发症状、皮疹类型、抽搐、呕吐、肝功能异常等方面的差异无显著性(P>0.05)。结论多因素logistic回归分析表明,持续高热、肢体无力、心率≥150次/min和血糖>8.3mmol/L共同构成了重症手足口病进展为神经源性肺水肿的高危因素,而初诊确诊手足口病则为保护性因素。
Objective To study the risk factors for the progression of HFMD to neurogenic pulmonary edema and provide evidence for the early diagnosis and intervention of neurogenic pulmonary edema. Methods From April 1, 2010 to October 30, 2010 in Shijiazhuang City Fifth Hospital for treatment of critically ill patients with hand, foot and mouth disease, depending on whether the progress of neurogenic pulmonary edema were grouped, select gender and age as a matching factor A 1: 3 ratio case-control study was performed. Results The two groups of children were diagnosed HFMD at initial diagnosis, HFMD ≥39 ℃, fever (temperature ≥38.5 ℃ and duration ≥3d) Limb weakness, shallow breathing or irregular rhythms, pulmonary murmur, blood pressure ≥130 mm Hg, heart rate ≥150 beats / min and oxygen saturation ≤91%, peripheral leukocyte count> 12 × 109 / L, blood glucose> 8.3 mmol / L, creatine kinase increased, the incidence of C-reactive protein and other factors were significant differences (P <0.05), while the initial symptoms, rash types, convulsions, vomiting, liver dysfunction and other aspects of the difference was not significant P> 0.05). Conclusion Multivariate logistic regression analysis showed that persistent high fever, limb weakness, heart rate ≥150 beats / min and blood glucose> 8.3mmol / L together constitute the risk factors for progression of severe HFMD to neurogenic pulmonary edema. However, newly diagnosed HFMD Disease is a protective factor.