手足口病重症病例诊疗状况评估
发布时间：2018-08-19 13:05
【摘要】：研究背景2010年卫生部对《手足口病诊疗指南(2008年版)》进行修订后颁发了《手足口病诊疗指南(2010年版)》,以规范手足口病的诊断和治疗。2010年3月,世界卫生组织(WHO)制定了《手足口病临床管理和公共卫生应对指南》。为更好地了解我国手足口病重症病例现行诊断和治疗状况,特在全国部分地区开展手足口病重症病例诊疗状况评估。 研究目的掌握全国传染病疫情报告系统手足口病重症病例诊断的状况,并为进一步完善我国手足口病重症病例报告标准、评估手足口病疾病负担提供参考依据。 研究方法选择2011年1-5月报告手足口病重症病例数前五位的河南、山东、浙江、四川、云南等五个省份为研究地区,运用系统抽样方法,随机抽取15个地市、32家医院通过传染病报告信息系统所报告的手足口病重症病例为调查对象,采用现场查看住院手足口病重症病例病案,用统一调查表提取病例临床表现、用药情况及疾病诊断等情况,并对主治医生进行访谈等方式,收集手足口病重症病例的临床特征和治疗等信息。对收集的临床特征及诊断分类情况进行描述性分析,并与我国手足口病诊断标准及WHO的有关指南的符合程度进行比较。 研究结果(1)诊断状况评估：依据国内标准,临床诊断重症病例中97%符合国内重症病例诊断标准,3%病例符合普通型病例诊断标准。实验室确诊病例中,97.5%符合国内重症病例诊断标准,2.5%病例符合普通型病例诊断标准。依据WHO标准,临床诊断重症病例中86%符合WHO手足口病并发症诊断标准,14%病例仅符合轻症病例诊断标准。实验室确诊病例中91%符合WHO手足口病并发症诊断标准,9%病例仅符合轻症病例诊断标准。针对国内《手足口病诊疗指南》(2010版)标准和WHO推荐《指南》标准进行一致性检验。结果显示：两种标准对重症病例诊断一致性弱(Kappa系数为0.027)。 (2)重点治疗药物使用状况评估：国内标准诊断的普通病例和重症病例中,糖皮质激素类药物使用率分别为90%和95%,抗病毒药物使用率分别为90%和77%,抗生素使用率分别为80%和87%,免疫制剂使用率分别为75%和63%,退热镇痛类药物使用率均为45%,血管活性药物使用率分别为15%和17%,两类病例的药物使用无统计学差异；脱水降压类药物使用率分别为70%和92%(P=0.001),中草药类药物使用率分别为55%和78%(P=0.01),止惊镇静类药物使用率分别为5%和25%(P=0.04),两类病例的药物使用有统计学差异。WHO标准诊断的EV71病例中轻症病例和并发症病例抗生素,中草药类药物和糖皮质激素类药物的使用情况无统计学差异,其他药物的使用有统计学差异。 (3)机械通气使用状况评估：依据国内标准诊断的普通病例均未使用机械通气,重症病例使用机械通气率为21%。依据WHO标准诊断的轻症病例和并发症病例中,1.4%轻症病例实施机械通气,2.7%神经系统受累病例实施机械通气,29%早期心肺衰竭病例实施机械通气,83%晚期心肺衰竭病例实施机械通气。 研究结论(1)手足口病重症病例基本符合我国手足口病重症病例和WHO并发症诊断标准,但少数病例符合普通型诊断标准。(2)我国《手足口病诊疗指南》(2010版)标准和WHO推荐的《手足口病临床管理和公共卫生应对指南》两种标准在重症病例诊断方面,存在不一致性,我国诊疗指南的敏感性较高。(3)国内和WHO指南中提倡的免疫制剂、退热镇痛类药物、血管活性药物和止惊镇静类药物使用比例不高,而不推荐使用或有适条件的的糖皮质激素类药物,抗生素的使用占较大比例。(4)机械通气使用指征未能按照国内标准和WHO提倡标准执行。
[Abstract]:Background The Ministry of Health issued the Hand Foot and Mouth Disease Diagnosis and Treatment Guidelines (2010 edition) after the revision of the Hand Foot and Mouth Disease Diagnosis and Treatment Guidelines (2008 edition) in 2010 to standardize the diagnosis and treatment of Hand Foot and Mouth Disease. In March 2010, the World Health Organization (WHO) formulated the Hand Foot and Mouth Disease Clinical Management and Public Health Response Guidelines. The current status of diagnosis and treatment of severe cases of foot and mouth disease has been assessed in some parts of the country.
Objective To understand the status of diagnosis of severe cases of hand-foot-mouth disease (HFMD) in the national infectious disease epidemic reporting system, and to provide reference for further improving the reporting standard of HFMD in China and evaluating the burden of HFMD.
Methods Five provinces, including Henan, Shandong, Zhejiang, Sichuan and Yunnan, which reported the top five severe cases of HFMD from January to May 2011, were selected as the study areas. Fifteen cities and 32 hospitals were randomly selected by systematic sampling method. The severe cases of HFMD reported by infectious disease reporting information system were investigated. To investigate the case history of severe cases of hand-foot-mouth disease (HFMD), extract the clinical manifestations, drug use and disease diagnosis with a unified questionnaire, and collect the clinical characteristics and treatment information of HFMD by interviewing the attending doctors. It was compared with the diagnostic criteria of HFMD and WHO in China.
Results (1) Diagnostic status evaluation: According to the domestic standards, 97% of the clinically diagnosed severe cases met the diagnostic criteria of the domestic severe cases, 3% of the cases met the diagnostic criteria of the common cases, 97.5% of the laboratory-confirmed cases met the diagnostic criteria of the domestic severe cases, and 2.5% of the cases met the diagnostic criteria of the common cases. 86% of the severe cases met the WHO criteria for the diagnosis of hand-foot-mouth disease complications, and 14% only met the criteria for the diagnosis of mild cases.91% of the laboratory-confirmed cases met the WHO criteria for the diagnosis of hand-foot-mouth disease complications, and 9% only met the criteria for the diagnosis of mild cases. The results showed that the diagnostic consistency between the two criteria was weak (Kappa coefficient was 0.027).
(2) Assessment of the usage of key therapeutic drugs: The usage rates of glucocorticoids were 90% and 95% respectively in common and severe cases diagnosed by national standards, 90% and 77% in antiviral drugs, 80% and 87% in antibiotics, 75% and 63% in immune preparations, respectively. The usage rates of vasoactive drugs were 45%, 15% and 17% respectively, and there was no significant difference between the two groups. The usage rates of dehydration and antihypertensive drugs were 70% and 92% (P = 0.001), the usage rates of Chinese herbal drugs were 55% and 78% (P = 0.01), the usage rates of anticonvulsants and sedatives were 5% and 25% (P = 0.04), respectively. The use of antibiotics, Chinese herbal medicines and glucocorticoids in EV71 cases were not significantly different from those in mild cases and complications, while the use of other medicines was statistically different.
(3) Assessment of the use of mechanical ventilation: no mechanical ventilation was used in common cases diagnosed according to domestic standards, and the rate of mechanical ventilation was 21% in severe cases. Mechanical ventilation was performed in exhaustive cases, and mechanical ventilation was performed in 83% patients with late cardiopulmonary failure.
Conclusion (1) Severe cases of HFMD basically meet the diagnostic criteria of severe cases of HFMD and complications of WHO in China, but a few cases meet the general diagnostic criteria. (2) China's "Hand-Foot-Mouth Disease Diagnosis and Treatment Guidelines" (2010 edition) standard and WHO recommended "Hand-Foot-Mouth Disease Clinical Management and Public Health Response Guidelines" (WHO) two standards for severe cases. In the aspect of diagnosis, there are inconsistencies, and the sensitivity of the guidelines in China is higher. (3) The proportion of immunologicals, antipyretic analgesics, vasoactive drugs and anticonvulsant sedatives advocated in the guidelines of China and WHO is not high, but the use of glucocorticoids or suitable conditions is not recommended, and the use of antibiotics accounts for a large proportion. (4) Indications for mechanical ventilation failed to be implemented in accordance with domestic standards and WHO standards.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.1
本文编号：2191734
[Abstract]:Background The Ministry of Health issued the Hand Foot and Mouth Disease Diagnosis and Treatment Guidelines (2010 edition) after the revision of the Hand Foot and Mouth Disease Diagnosis and Treatment Guidelines (2008 edition) in 2010 to standardize the diagnosis and treatment of Hand Foot and Mouth Disease. In March 2010, the World Health Organization (WHO) formulated the Hand Foot and Mouth Disease Clinical Management and Public Health Response Guidelines. The current status of diagnosis and treatment of severe cases of foot and mouth disease has been assessed in some parts of the country.
Objective To understand the status of diagnosis of severe cases of hand-foot-mouth disease (HFMD) in the national infectious disease epidemic reporting system, and to provide reference for further improving the reporting standard of HFMD in China and evaluating the burden of HFMD.
Methods Five provinces, including Henan, Shandong, Zhejiang, Sichuan and Yunnan, which reported the top five severe cases of HFMD from January to May 2011, were selected as the study areas. Fifteen cities and 32 hospitals were randomly selected by systematic sampling method. The severe cases of HFMD reported by infectious disease reporting information system were investigated. To investigate the case history of severe cases of hand-foot-mouth disease (HFMD), extract the clinical manifestations, drug use and disease diagnosis with a unified questionnaire, and collect the clinical characteristics and treatment information of HFMD by interviewing the attending doctors. It was compared with the diagnostic criteria of HFMD and WHO in China.
Results (1) Diagnostic status evaluation: According to the domestic standards, 97% of the clinically diagnosed severe cases met the diagnostic criteria of the domestic severe cases, 3% of the cases met the diagnostic criteria of the common cases, 97.5% of the laboratory-confirmed cases met the diagnostic criteria of the domestic severe cases, and 2.5% of the cases met the diagnostic criteria of the common cases. 86% of the severe cases met the WHO criteria for the diagnosis of hand-foot-mouth disease complications, and 14% only met the criteria for the diagnosis of mild cases.91% of the laboratory-confirmed cases met the WHO criteria for the diagnosis of hand-foot-mouth disease complications, and 9% only met the criteria for the diagnosis of mild cases. The results showed that the diagnostic consistency between the two criteria was weak (Kappa coefficient was 0.027).
(2) Assessment of the usage of key therapeutic drugs: The usage rates of glucocorticoids were 90% and 95% respectively in common and severe cases diagnosed by national standards, 90% and 77% in antiviral drugs, 80% and 87% in antibiotics, 75% and 63% in immune preparations, respectively. The usage rates of vasoactive drugs were 45%, 15% and 17% respectively, and there was no significant difference between the two groups. The usage rates of dehydration and antihypertensive drugs were 70% and 92% (P = 0.001), the usage rates of Chinese herbal drugs were 55% and 78% (P = 0.01), the usage rates of anticonvulsants and sedatives were 5% and 25% (P = 0.04), respectively. The use of antibiotics, Chinese herbal medicines and glucocorticoids in EV71 cases were not significantly different from those in mild cases and complications, while the use of other medicines was statistically different.
(3) Assessment of the use of mechanical ventilation: no mechanical ventilation was used in common cases diagnosed according to domestic standards, and the rate of mechanical ventilation was 21% in severe cases. Mechanical ventilation was performed in exhaustive cases, and mechanical ventilation was performed in 83% patients with late cardiopulmonary failure.
Conclusion (1) Severe cases of HFMD basically meet the diagnostic criteria of severe cases of HFMD and complications of WHO in China, but a few cases meet the general diagnostic criteria. (2) China's "Hand-Foot-Mouth Disease Diagnosis and Treatment Guidelines" (2010 edition) standard and WHO recommended "Hand-Foot-Mouth Disease Clinical Management and Public Health Response Guidelines" (WHO) two standards for severe cases. In the aspect of diagnosis, there are inconsistencies, and the sensitivity of the guidelines in China is higher. (3) The proportion of immunologicals, antipyretic analgesics, vasoactive drugs and anticonvulsant sedatives advocated in the guidelines of China and WHO is not high, but the use of glucocorticoids or suitable conditions is not recommended, and the use of antibiotics accounts for a large proportion. (4) Indications for mechanical ventilation failed to be implemented in accordance with domestic standards and WHO standards.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R725.1
【参考文献】
相关期刊论文 前10条
1 李秀勇;韩明锋;冉献贵;陈晓枫;孟晓林;单南冰;;57例重症手足口病临床特点及救治分析[J];安徽医学;2008年05期
2 朱理业;丁振涛;万俊峰;刘奇泉;将_";徐海洋;李晓鹏;张勇;薛彬;王维;田亚贞;见海晖;;阜阳市手足口病(EV71感染)重症病例流行病学调查分析[J];安徽医学;2008年05期
3 范晓晨;都鹏飞;;血糖监测对小儿手足口病病情和预后判断的价值分析[J];安徽医学;2009年03期
4 杜杰;丁振涛;万俊峰;朱理业;;阜阳市手足口病死亡患儿流行病学特征分析[J];安徽医学;2009年03期
5 魏广友;都鹏飞;范晓晨;夏正坤;;204例重症手足口病临床分析[J];安徽医学;2009年03期
6 随素敏;都鹏飞;;机械通气治疗重症手足口病合并急性肺水肿10例临床分析[J];安徽医学;2009年03期
7 郑慧贞;李剑森;康敏;张永慧;何剑峰;郭汝宁;杨芬;梁文佳;邓爱萍;张正敏;张锦清;李灵辉;孙立梅;;广东省手足口病确诊病例发病及诊疗情况调查[J];华南预防医学;2008年05期
8 李秀菊;韩丹;贾伟华;徐锐;杨俊伟;李蓬;许汴利;;102例手足口病临床特征分析[J];河南预防医学杂志;2010年01期
9 王琦;王子军;;2008年中国手足口病流行特征分析[J];疾病监测;2010年03期
10 郭青;张春曦;王晓风;刘世炜;王丽萍;;2008-2009年中国大陆手足口病流行特征分析[J];疾病监测;2011年11期
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