重庆市手足口病重症及死亡病例影响因素研究

发布时间：2018-06-18 12:15

本文选题：手足口病 + 重症病例　；参考：《第三军医大学》2016年硕士论文

【摘要】：手足口病(Hand-foot-mouth disease,HFMD)是一种全球性的传染病,近年来,手足口病的发病率在中国及亚太地区的不同国家呈逐步上升的趋势,同时,还有较多重症和死亡病例报告,给社会及家庭带来极大的影响。在我国,手足口病已于2008年5月被纳入法定丙类传染病报告管理。我国手足口病主要是以婴幼儿最为易感,多发于4月-9月,主要表现为手、足、口腔等处出现皮疹或疱疹,对大部分病情较轻的患儿来说都可以治愈,但若处理不合理或不及时可能导致一部分病情严重的患儿出现无菌性脑膜炎、心肌炎、肺出血等并发症,甚至出现死亡。引起手足口病的病原体是肠道病毒,而且肠道病毒的种类较多,在中国,手足口病病原体中以肠道病毒71型(EV71)和柯萨奇病毒A16型(Cox A16)最多,且重症及死亡病例多由EV71感染引起。手足口病的传染源包括病例和隐性感染者,其传播的途径及方式相对较多。由于手足口病传染性强、传播途径复杂、儿童普遍易感,所以控制难度大。研究目的1.了解重庆市手足口病病例及其家庭的一般特征;手足口病病例的发病、诊疗情况;既往史及其他相关信息情况;样本采集及实验室检查情况;临床症状、体征及并发症的总体分布情况。2.了解重庆市手足口病重症病例与轻症病例之间、重症死亡病例与重症非死亡病例之间上述5方面特征的分布差异。3.探讨重庆市儿童重症手足口病病例的影响因素,以及重症手足口病病例发生死亡的影响因素,为今后征对性开展干预工作,降低重症病例的发病率和病死率提供参考。对象与方法收集2011年—2014年重庆市(样本来源于重庆市儿童医院)90例重症手足口病和90例轻症手足口病病例,重症病例包括52例重症非死亡病例及38例重症死亡病例,进行重症与轻症病例及重症死亡与重症非死亡病例的影响因素分析。采用一对一问询及查看就医病案相结合的方式完成统一的调查表,调查内容包括:手足口病病例及其家庭的一般特征;手足口病病例的发病、就诊及诊疗情况;既往史及其他相关信息情况;样本采集及实验室检查情况;临床症状、体征及并发症的总体分布情况。资料应用Epi Data 3.1软件进行录入,建立数据库,使用SPSS 19.0软件进行描述性分析、单因素分析和多因素非条件logistic回归分析。研究结果1.本次研究共调查180例手足口病病例,重症、轻症病例各90(50%)例,其中重症病例中死亡38例(占重症病例的42.2%);男性117(65.0%)例,女性63(35%)例;年龄范围4个月~6岁,平均年龄1.64±1.22岁,其中,婴幼儿(≤3岁)167例(占92.8%),学龄前期儿童(4~6岁)13例(占7.2%)。采集了172例病例的样本,采集最多的样本类型是粪便135例(78.5%),标本中任一项检测为阳性的有140例,阳性率81.40%,其中病毒类型最多的为EV71有85例,检出率为49.71%。2.调查对象发病与初次就诊时间间隔都较短,平均都在1天以内;初次就诊与确诊的时间间隔平均接近2天。65.6%的调查对象初诊医院类型是县级及以下级别的医疗机构,有62.2%的病例初诊漏诊手足口病,84.4%的病例首次确诊手足口病是在市级及以上医院。县级及以下医疗机构对手足口病的漏诊率较高,为68.67%,随着医院级别升高,对手足口病的漏诊率逐渐降低。3.调查对象中有168例(93.33%)有发热症状,有58例(32.22%)出现咳嗽症状,有175例(97.22%)有出疹症状,疹子类型最多的是丘疹和疱疹,分别有141例(78.33%)和106例(58.89%)病例出现,出疹部位最多的是出现在手、足部,均占85%以上。4.被调查患儿并发症及体征出现最多的是神经系统,其次是呼吸系统,依次有98.3%、83.3%的患儿出现。神经系统出现最多的并发症及体征前3项为:瞳孔状态异常(95.56%)、精神差(53.33%)、易惊(32.78%);呼吸系统出现最多的并发症及体征前3项依次为:咽痛(38.89%)、咳嗽(25.00%)、口唇紫绀(25.00%);循环系统出现最多的并发症及体征前3项依次为:心率加快(43.33%)、四肢发凉(20.00%)、面色/手/脚未端苍白发灰(17.78%);消化系统出现的并发症及体征主要为呕吐(34.44%)。5.重症手足口病与轻症手足口病两组间单因素分析发现:病毒类型、户口类型、现住址类型、照看人文化程度、初次就诊医院类型、初诊是否确诊手足口病、发病与初诊间隔时间、初诊与确诊间隔时间、是否发热、最高温超39℃、是否出疹、出疹持续时间、出现消化系统并发症、出现循环系统并发症等在两组间的分布有统计学差异。6.重症手足口死亡病例与重症手足口非死亡病例两组间单因素分析发现:性别、户口类型、发病季节、家庭14岁以下儿童数、初次就诊的医院类型、发热症状平均持续时间、出疹平均持续时间、咽峡部有疱疹或溃疡、出现消化系统的并发症、出现深昏迷、呼吸困难、指/趾或口唇发绀、脉搏减弱、出现呕吐、咖啡色呕吐物在两组间的分布有统计学差异。7.多因素分析发现,手足口病病例发生重症的影响因素有现住地类型为农村、初次就诊未确诊手足口病、感染的病毒类型为EV71、出现循环系统并发症4个因素,均为OR值1。重症手足口病病例发生死亡的影响因素有:家庭成员中14岁以下儿童数、发热持续时间、出疹持续时间、出现深昏迷、出现呕吐5个因素,前3个因素OR值1,后2个因素OR值1。结论通过对2011年—2014年重庆市180例手足口病病例的调查研究,得出以下结论:1.提高县级及以下医疗机构对手足口病诊治能力,在手足口病的防控过程中显得尤为重要,加强对县级及以下医疗机构的相关培训已迫在眉睫。2.要加强对农村幼儿园及家庭的预防保健宣传,当发现儿童出现发热和手、足、口腔部出疹症状时,要高度重视,及时到医院诊治。3.提高医疗机构对手足口病的确诊能力,当发现患儿感染病毒类型为EV71或者出现循环系统并发症时,及时对患儿进行对症治疗,有助于降低重症手足口病病例的发生率。4.提高重症手足口病病例可能发生死亡的早期提示因素的识别能力,当发现患儿出现昏迷及呕吐症状时,加强对患儿的密切观察和护理治疗,降低重症手足口病病例的死亡率。
[Abstract]:Hand-foot-mouth disease (HFMD) is a global infectious disease. In recent years, the incidence of hand foot and mouth disease (HFMD) in different countries in China and the Asia Pacific region is on the rise. At the same time, there are many cases of severe and fatal cases, which have great influence on the society and family. In China, the hand foot and mouth disease was in May 2008. China's hand foot and mouth disease is mainly based on children's most susceptible, mostly in -9 months of April. The main manifestations are rash or herpes in the hands, feet, and oral cavity, which can be cured for most children with mild condition, but if the treatment is unreasonable or not in time, a part of the disease may cause serious illness. There are complications of aseptic meningitis, myocarditis, pulmonary hemorrhage, and even death. The pathogen of hand foot and mouth disease is enterovirus, and there are many kinds of enteroviruses. In China, among the pathogens of hand foot and mouth disease, enterovirus 71 (EV71) and coxsackievirus A16 (Cox A16) are the most, and most of the severe and fatal cases are infected by EV71 The infectious sources of hand foot and mouth disease include cases and recessive infection, and the way and way of transmission are relatively more. Because of the strong contagion of the hand foot and mouth disease, the transmission route is complex and the children are easily susceptible, so the control is difficult. 1. the general characteristics of the cases of hand foot and mouth disease and their families in Chongqing, the incidence of hand foot and mouth disease cases, the diagnosis of hand foot and mouth disease cases, and the diagnosis of hand foot and mouth disease cases, and the diagnosis of hand foot and mouth disease cases, the disease, diagnosis and treatment of hand foot and mouth disease. The situation of treatment, past history and other related information, sample collection and laboratory examination, clinical symptoms, signs and the overall distribution of the complications.2. understand the distribution difference between the 5 aspects of the severe cases of hand, foot and mouth disease and light disease in Chongqing, the distribution difference between the severe death cases and the severe non death cases.3. discussion on the distribution difference between Chongqing and the severe cases of severe and severe non death cases The influencing factors of severe hand foot and mouth disease cases in children and the factors affecting the death of severe hand foot and mouth disease cases, provide reference for the future sign of sexual intervention, reduce the incidence and mortality of severe cases, and collect 90 cases of severe hands from 2011 to 2014 in Chongqing (sample from Chongqing children's Hospital). Cases of foot and mouth disease and 90 cases of light hand foot and mouth disease, severe cases including 52 cases of severe non death and 38 cases of severe death, the analysis of influencing factors of severe and light cases, severe and severe and severe non death cases were analyzed. A unified questionnaire was completed by one to one inquiry and the examination of medical records. Including: the general characteristics of cases of hand foot and mouth disease and their families; the incidence of hand foot and mouth disease cases, medical treatment and diagnosis and treatment; previous history and other related information; sample collection and laboratory examination; clinical symptoms, signs and the overall distribution of complications. Data should be recorded with Epi Data 3.1 software to establish a database and use SPSS 19 the 19 software performed descriptive analysis, single factor analysis and multi factor non conditional logistic regression analysis. Results 1. this study investigated a total of 180 cases of hand foot and mouth disease, 90 (50%) cases of severe and mild cases, of which 38 cases died in severe cases (42.2% of severe cases), 117 (65%) cases, 63 (35%) cases in males and 180 months of age for 4 ~6 The average age was 1.64 + 1.22 years old, of which 167 cases (92.8%) of infants (92.8%) and 13 cases (4~6 years old) were 13 cases (7.2%). Samples of 172 cases were collected, the most sample type was fecal 135 cases (78.5%), 140 cases were positive in any specimen, and the positive rate 81.40%, of which the most virus type was 85 in EV71. The detection rate was 49.71%.2., the time interval between the first visit and the first visit was shorter, the average was within 1 days, and the time interval between the first visit and the diagnosis was close to 2 days.65.6%. The type of first diagnosis hospital was at the county level and the following level of medical institutions, 62.2% cases were first missed diagnosis of hand foot and mouth disease, and 84.4% of the cases were first confirmed. The rate of hand foot and mouth disease is at the city level and above. The rate of missed diagnosis of hand foot and mouth disease is higher in county and below medical institutions, which is 68.67%. As the hospital level rises, 168 cases (93.33%) have fever symptoms, 58 cases (32.22%) have cough symptoms, 175 cases (97.22%) have rash symptoms, and rash, with the level of hospital level rising, the rate of missed diagnosis of hand foot and mouth disease is gradually reduced by.3.. The most subtypes were papules and herpes. There were 141 cases (78.33%) and 106 cases (58.89%). Most of the eruptions were in the hands and feet. More than 85% of the.4. were found in the nervous system, followed by the respiratory system, 98.3% and 83.3% of the children. The first 3 complications and physical signs were: abnormal pupil (95.56%), mental poor (53.33%), and easy to panic (32.78%); the most common complications and physical signs of the respiratory system were: sore pain (38.89%), cough (25%), and lip cyanosis (25%); the most complications and the first 3 items of the circulation system were: heart rate acceleration (43.33%), extremities hair. Cold (20%), face color / hand / foot pallous gray hair ash (17.78%); the complications and signs of the digestive system were mainly vomiting (34.44%).5. severe hand foot and mouth disease and light hand foot and mouth disease two groups of single factor analysis found: virus type, residence type, present address type, look after people's cultural degree, primary hospital type, first diagnosis of the diagnosis of hand Foot and mouth disease, the interval time between the first diagnosis, the interval time between the first diagnosis and diagnosis, the fever, the highest temperature over 39 C, the rash, the duration of the rash, the occurrence of the digestive system complications and the circulation system complications, there were statistical differences between the two groups of.6. severe hand foot and foot death cases and the severe hand foot and foot non death cases between two groups. Single factor analysis found that the number of children under the age of 14 years, the number of children under 14 years of age, the type of the first visit, the average duration of fever, the average duration of the eruption, the herpes and ulcers in the pharynx isthmus, the complications of the digestive system, the deep coma, dyspnea, the cyanosis of the fingers / toes or lips, the weakening of pulse and vomiting. The distribution of the coffee colored vomit in the two groups was statistically different.7. multiple factors analysis found that the factors affecting the severe cases of hand foot and mouth disease were in rural areas, the first undiagnosed hand foot and mouth disease, the infection virus type was EV71, the circulation system and the onset of 4 factors were all OR 1. cases of severe hand foot and mouth disease. The influencing factors of death were: the number of children under 14 years of age, duration of fever, duration of rash, deep coma, vomiting 5 factors, the first 3 factors OR value 1, and the latter 2 factors OR value 1. conclusion through the investigation and study of 180 cases of hand foot and mouth disease in Chongqing from 2011 to 2014, the following conclusions are concluded: 1. raise the county level. The ability to treat and treat hand foot and mouth disease is particularly important in the prevention and control of hand foot and mouth disease. It is imminent to strengthen the training of medical institutions at the county level and below..2. should strengthen the prevention and health publicity of Rural Kindergartens and families. When children find fever and hands, feet, and mouth eruptions, they should be higher. Attention should be paid to the diagnosis and treatment of.3. in the hospital in time to improve the diagnosis of hand foot and mouth disease. When it is found that the virus type is EV71 or the complication of circulatory system, it is timely to treat the children with symptomatic treatment, which can help to reduce the incidence of severe hand foot and mouth disease (.4.) and improve the possible death of HFMD cases. The ability to identify the early factors, when they found the symptoms of coma and vomiting, strengthen the close observation and nursing care of the children, and reduce the mortality of severe hand foot and mouth disease.
【学位授予单位】：第三军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R725.1

【参考文献】