肠道病毒71型小儿脑炎重症初期相关因素分析

发布时间：2018-05-10 15:09

  本文选题：肠道病毒71型 + 小儿病毒性脑炎　； 参考：《青岛大学》2017年硕士论文

【摘要】：目的调查肠道病毒71型小儿脑炎重症的发生情况。通过分析普通组、重症组患儿临床特点,探讨初期引起重症病例的危险因素。为早期识别重症肠道病毒71型小儿脑炎、制定合理的诊疗计划,降低致残率提供临床依据。提高护士对重症肠道病毒71型小儿脑炎初期临床特点的认识,确立简单的病情评估标准,及时发现病情变化、有效干预。方法本研究采用回顾性研究方法。根据病毒核酸经反转录聚合酶链反应(RT-PCR)检测结果,使用自行设计的调查表收集2014年12月-2016年11月在青岛大学附属医院、青岛市妇女儿童医院儿内科首次确诊为肠道病毒71型小儿脑炎入院72h内相关资料。比较普通组、重症组在一般资料、临床表现、体征及实验室指标等方面的差异。有意义影响因素(P0.05)纳入Logistic回归分析。结果本研究共搜集肠道病毒71型小儿脑炎重症组62例、普通组125例。187例入院患者重症发生率33.16%(62/187)。1.一般资料方面:重症肠道病毒71型小儿脑炎的发生率男性高于女性,农村高于城镇,与普通病例相比差异具有统计学意义(P0.05)。重症EV71型小儿脑炎患病年龄集中在3岁及以下。2.临床表现、体征方面:肠道病毒71型小儿脑炎重症组初期呕吐、惊厥、肢体抖动、病理征阳性、脑电图异常的发生率较普通组差异有统计学意义(P0.05)。重症组肠道病毒71型小儿脑炎初期腋温大于38℃持续时间(h)及腋下最高体温(℃)与普通组相比具有显著性差异(P0.05)。3.实验室检查方面:重症组肠道病毒71型小儿脑炎初期白细胞计数、中性粒细胞计数、淋巴细胞计数、空腹血糖、肌酸激酶同工酶相比普通组差异具有统计学意义(P0.05)。4.Logistic回归结果:腋温大于38℃持续时间(h)(OR=1.084,95%CI:1.040~1.131)、肢体抖动(OR=11.233,95%CI:2.242~56.287)、病理征(OR=4.137,95%CI:1.436~11.912)、空腹血糖升高(OR=2.350,95%CI:1.357~4.069)、白细胞计数升高(OR=1.449,95%CI:1.232~1.704)是重症EV71型小儿脑炎初期的危险因素。结论1.重症肠道病毒71型小儿脑炎初期症状和体征包括:呕吐、惊厥、肢体抖动、病理征阳性、脑电图异常、腋温大于38℃持续时间(h)较长及腋下最高体温(℃)较高,中性粒细胞计数、白细胞计数、肌酸激酶同工酶、空腹血糖明显升高。2.护士应加强对初期出现肢体抖动、病理征阳性,空腹血糖、白细胞计数明显升高,持续高热不退的低龄患儿的评估和监护,及时干预,减少重症发生。
[Abstract]:Objective to investigate the severity of enterovirus 71 encephalitis in children. By analyzing the clinical characteristics of children in common group and severe group, the risk factors of early severe cases were discussed. It provides clinical basis for early identification of severe enterovirus 71 encephalitis in children, rational diagnosis and treatment plan and reduction of disability rate. To improve nurses' understanding of the clinical characteristics of severe enterovirus 71 encephalitis in early stage, to establish a simple assessment standard, to detect the changes in the condition in time, and to intervene effectively. Methods retrospective study was used in this study. According to the results of reverse transcriptase polymerase chain reaction (RT-PCR), a self-designed questionnaire was used to collect virus nucleic acid from December 2014 to November 2016 at the affiliated Hospital of Qingdao University. Clinical data of children with enterovirus 71 encephalitis were first diagnosed in Qingdao Women and Children Hospital within 72 hours. The differences in general data, clinical manifestations, physical signs and laboratory indexes were compared between the general group and the severe group. Significant influencing factors (P 0.05) were included in Logistic regression analysis. Results in this study, 62 cases of severe encephalitis of enterovirus 71 and 125 cases of normal group. 187 cases were admitted to hospital, the incidence of severe disease was 33.16 / 62 / 187 ~ (-1). General data: the incidence of severe enterovirus 71 encephalitis in children was higher in males than in females and higher in rural areas than in urban areas. The age of severe EV71 encephalitis in children was 3 years old and below. 2. Clinical manifestations and signs: the incidence of early vomiting, convulsion, limb jitter, pathological sign and abnormal EEG in severe group of enterovirus 71 encephalitis was significantly higher than that in normal group (P 0.05). There were significant differences in axillary temperature (> 38 鈩，

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