Liu Tao, Jiang Bao-fa, Niu Wen-ke, Ding Shu-jun, Wang Lian-sen, Sun Da-peng, Pei Yao-wen, Lin Yi, Wang Jian-xing, Pang Bo, Wang Xian-jun
Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan 250012, China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2013 Apr;47(4):333-6.
To understand the clinical features of death from hand, foot and mouth disease (HFMD) and to explore the early warning index of HFMD death.
A total of 41 HFMD death cases were collected as case group in Shandong province between 2009 and 2011, and another 123 serious HFMD cases were selected as control group according to the similar gender, place of origin and hospital level, with the ratio at 1:3. We investigated the general situation, clinical treatment, past medical history, clinical symptoms and signs of the ill children, and applied the conditional logistic regression to explore early warning index of HFMD death.
The rate of patients who had symptoms in nervous system, digestive system, circulatory system and respiratory system were separately 90.2% (37/41), 58.5% (24/41), 53.7% (22/41) and 90.2% (37/41) in case group; and the proportions were 44.7% (55/123), 13.8% (17/123), 10.6% (13/123) and 12.2% (15/123) respectively in control group. The difference between the two groups showed statistical significance (χ(2) = 25.881, 32.791, 34.011, 86.505, P < 0.05). In case group, 37 patients had neurogenic pulmonary edema, 26 patients got encephalitis, 15 patients had respiratory and circulatory failure, 7 patients got pulmonary hemorrhage, 4 patients had multiple organ failure, 4 patients got myocarditis and 1 patient had cerebral hernia. According to multi-factor logistic regression analysis, the early warning indicators of HFMD death included neck resistance (case group: 34.1% (14/41), control group: 4.1% (5/123); OR = 7.145, 95%CI: 1.748 - 29.204), vomiting (case group: 58.5% (24/41), control group: 13.8% (17/123); OR = 5.632, 95%CI: 1.793 - 17.685) and increase of heart rate (case group: 53.7% (22/41), control group: 10.6% (14/123), OR = 6.370, 95%CI: 1.517 - 26.743).
In the process of clinical treatment and care, we should interfere the serious HFMD patients with neck resistance, vomiting and increase of heart rate, and thereby reduce the death from HFMD.
了解手足口病（HFMD）死亡病例的临床特征，探索手足口病死亡的早期预警指标。
收集2009年至2011年山东省41例手足口病死亡病例作为病例组，按照性别、籍贯、医院级别相近的原则，选取123例重症手足口病病例作为对照组，病例与对照的比例为1∶3。调查患儿的一般情况、临床治疗、既往病史、临床症状及体征等，应用条件logistic回归分析探索手足口病死亡的早期预警指标。
病例组神经系统、消化系统、循环系统、呼吸系统有症状的患者比例分别为90.2%（37/41）、58.5%（24/41）、53.7%（22/41）、90.2%（37/41）；对照组上述比例分别为44.7%（55/123）、13.8%（17/123）、10.6%（13/123）、12.2%（15/123）。两组比较差异有统计学意义（χ(2)=25.881、32.791、34.011、86.505，P<0.05）。病例组发生神经源性肺水肿37例，脑炎26例，呼吸循环衰竭15例，肺出血7例，多器官功能衰竭4例，心肌炎4例，脑疝1例。多因素logistic回归分析显示，手足口病死亡的早期预警指标为颈抵抗（病例组：34.1%（14/41），对照组：4.1%（5/123）；OR=7.145，95%CI：1.748～29.204）、呕吐（病例组：58.5%（24/41），对照组：13.8%（17/123）；OR=5.632，95%CI：1.793～17.685）、心率增快（病例组：53.7%（22/41），对照组：10.6%（14/123），OR=6.370，95%CI：1.517～26.743）。
在临床治疗及护理过程中，应针对有颈抵抗、呕吐、心率增快的重症手足口病患者进行干预，从而降低手足口病的死亡。
