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目的探讨儿童重症手足口病(HFMD)并神经源性肺水肿(NPE)的死亡危险因素,以利于指导疾病早期认识、诊断和治疗,从而降低病死率。方法收集2010年3-6月本院PICU收治的42例重症HFMD并神经源性肺水肿患儿资料,并根据患儿预后将42例患儿分为存活组(对照组)和死亡组(死亡或放弃治疗后死亡),比较2组患儿性别、年龄、小儿危重症评分(PCIS)、多脏器功能不全综合征(MODS)受累器官数、白细胞计数、中性粒细胞比值、血小板计数、上机时血糖、上机时心率、上机时血压、乳酸水平、碱剩余(BE)、CK、CK-MB、肌钙蛋白、降钙素原(PCT)、CRP、肺出血、意识障碍、惊跳、氧合指数、应激性溃疡、循环衰竭、发病病程等24个因素。采用单因素分析,筛选出P<0.05的相关危险因素进行多因素Logistic回归分析,分析可能的死亡危险因素。结果 42例中死亡16例,病死率38.1%。肺出血18例(其中死亡14例),死亡16例中均有发热、惊跳及循环衰竭,15例手足或手足臀部有针尖样散在皮疹,1例无皮疹。合并3个脏器功能障碍者8例(其中4例死亡),4个脏器功能障碍的11例全部死亡,5个脏器功能障碍1例死亡。单因素分析显示,PCIS、MODS受累器官数、白细胞计数、中性粒细胞比值、血小板计数、上机时血糖、上机时心率、乳酸水平、BE、CK-MB、肌钙蛋白、肺出血、意识障碍、氧合指数、应激性溃疡和循环衰竭16个因素与重症HFMD并神经源性肺水肿的死亡有关。将以上因素进行多因素Logistic回归分析,仍然与死亡有关的因素包括血清乳酸值、CK-MB和PCIS。结论重症HFMD并神经源性肺水肿病死率高,尤其是出现肺出血及循环衰竭时。PCIS降低、乳酸水平升高和CK-MB增高是该病死亡的危险因素。
Objective To investigate the risk factors of death in children with severe HFMD and neurogenic pulmonary edema (NPE) in order to guide the early recognition, diagnosis and treatment of the disease and reduce the mortality. Methods Forty-two children with severe HFMD and neurogenic pulmonary edema received PICU in our hospital from March to June in 2010 were divided into survival group (control group) and death group (death group Or give up the treatment after the death), compared two groups of children gender, age, pediatric critical illness score (PCIS), multiple organ dysfunction syndrome (MODS) organ number, white blood cell count, neutrophil ratio, platelet count, Heart rate on the machine, blood pressure on the machine, lactate level, basic excess (BE), CK, CK-MB, troponin, procalcitonin (PCT), CRP, pulmonary hemorrhage, disturbance of consciousness, Shock, oxygenation index, stress ulcer, circulatory failure, pathogenesis and other 24 factors. By univariate analysis, the relevant risk factors of P <0.05 were screened by multivariate Logistic regression analysis to analyze the possible risk factors of death. Results Of the 42 cases, 16 died and the case fatality rate was 38.1%. Pulmonary hemorrhage in 18 cases (including 14 deaths), 16 patients died of fever, jaundice and circulatory failure, 15 cases of hand, foot or hand and foot buttocks scattered needle rash, 1 case without rash. Of the 3 patients with organ dysfunction, 8 (4 died), 4 had organ dysfunction, 11 died, and 5 had organ dysfunction, 1 died. Univariate analysis showed that there were significant differences in organ count, white blood cell count, neutrophil ratio, platelet count, blood glucose on the machine, heart rate on the machine, lactate level, BE, CK-MB, troponin, The disturbance of consciousness, oxygenation index, stress ulcer and circulatory failure were related to the death of severe HFMD and neurogenic pulmonary edema. Multiple factors Logistic regression analysis of the above factors, but still related to death factors, including serum lactate, CK-MB and PCIS. Conclusion Severe HFMD and neurogenic pulmonary edema with high mortality, especially in cases of pulmonary hemorrhage and circulatory failure. PCIS decreased, elevated levels of lactic acid and CK-MB increased risk of death of the disease.