Hsia Shao-Hsuan, Wu Chang-Teng, Chang Jia-Jen, Lin Tzou-Yien, Chung Hung-Tao, Lin Kuang-Lin, Hwang Mao-Sheng, Chou Min-Liang, Chang Luan-Yin
Divisions of Pediatric Critical Care and Emergency Medicine, Chang Gung Children's Hospital, Taoyuan, Taiwan.
Pediatr Infect Dis J. 2005 Apr;24(4):331-4. doi: 10.1097/01.inf.0000157219.19674.98.
Enterovirus 71 (EV71) can sometimes cause fatal or disabling diseases in children; therefore EV71-infected children with cardiopulmonary failure were investigated at Chang Gung Children's Hospital to discover the prognostic predictors.
We investigated 27 EV71-infected children with cardiopulmonary failure from May 2000 to September 2001 and analyzed their clinical data to find predictors associated with unfavorable outcomes of deaths or ventilator dependence.
Of the 27 patients, 8 (30%) died and 10 (37%) were ventilator-dependent. Troponin I levels correlated most strongly with fatality, with 5 of the 6 children with troponin I levels >40 ng/ml dying (P = 0.001). Other factors correlated with fatality were cerebrospinal fluid white blood cell count > or =100/microL (P = 0.002) and initial systolic pressure < or =100 mm Hg (P = 0.05). Of the 19 survivors, 10 (53%) were left with central hypoventilation, dysphagia and/or limb weakness plus atrophy. The factors associated with ventilator dependence included higher inotrope equivalent (P < 0.001), duration of hypotension > or =40 hours, initial blood systolic pressure < or =100 mm Hg, positive EV71 isolation and age > or =12 months.
Poor prognostic factors were related to cardiovascular and neurologic damage; therefore physicians may consider advanced cardiovascular support for EV71-infected children with cardiopulmonary failure.
肠道病毒71型（EV71）有时可导致儿童出现致命或致残性疾病；因此，长庚儿童医院对感染EV71且出现心肺衰竭的儿童进行了调查，以发现预后预测指标。
我们调查了2000年5月至2001年9月期间27例感染EV71且出现心肺衰竭的儿童，并分析了他们的临床数据，以找出与死亡或呼吸机依赖等不良结局相关的预测指标。
27例患者中，8例（30%）死亡，10例（37%）依赖呼吸机。肌钙蛋白I水平与死亡率的相关性最强，6例肌钙蛋白I水平>40 ng/ml的儿童中有5例死亡（P = 0.001）。与死亡率相关的其他因素包括脑脊液白细胞计数≥100/μL（P = 0.002）和初始收缩压≤100 mmHg（P = 0.05）。19例幸存者中，10例（53%）遗留有中枢性通气不足、吞咽困难和/或肢体无力伴萎缩。与呼吸机依赖相关的因素包括更高的血管活性药物等效剂量（P < 0.001）、低血压持续时间≥40小时、初始收缩压≤100 mmHg、EV71分离阳性以及年龄≥12个月。
不良预后因素与心血管和神经损伤有关；因此，医生对于感染EV71且出现心肺衰竭的儿童可考虑给予高级心血管支持。
