| Objective:The goal to expiore clinical feture of serious HFMD andrelated risk factors for prognosis.Methods:The clinical data of84children with serious HFMD seenfrom January2008to june2012in Children’s Hospital of ChongqingMedical University were analyzed retrospectively. According to theprognosis,84children were divided to cure group and death group. Riskfactors of serious HFMD related death were respectively analyzed by usingsingle factor analysis(X2test, t test),screened, and did the unconditionallogistic regression.Telephone for prognosis of parts survival cases.Results: In the84cases, there were57boys and27girls, with41casescure or improved and43deaths. The fatality rate of84patients is51.19%.The youngest among them was4months and21days old, the oldestwas14years and7months,88.1%of infants were under the age of3.50cases in3-6month(59.5%). The mean disease course of cure group was3.80±1.63d and mean disease course of death group was2.94±1.28d,thedisease course of the two groups had no significant statisticdifference(P=0.009).82cases had fever(97.62%),with thermal spike as39.28+0.74℃.82cases (97.62%) appeared rashes,and there27cases (65.85%) with3parts of lesions and more in cure group,while28cases(65.12%) with2parts of lesion and less in death group.In the deathgroup,the incidence of coma （P＜0.0001）, vomiting(P=0.016),tremors(P=0.019), cyanosis（P＜0.0001）, pulmonary hemorrhage(P＜0.0001), wet rales in lung(P＜0.0001), oxygen saturation decrease(P＜0.0001), complexion changes(P＜0.0001), acral circulatory disorders(P＜0.0001), hypotension (P＜0.0001)were significantly higher than those of thecure group,the respiratory rate(P=0.003) and heart rate (P＜0.0001)of theformer were significantly faster than those of the later, and the respiratorysystem (P＜0.0001)and circulatory system (P＜0.0001)involvement of theformer were significantly earlier than those of the later. In laboratoryexaminations, the white blood cell count(P=0.018), blood glucose(P＜0.0001), CK-MB(P=0.004), AST(P=0.003) of the death group were wassignificantly higher than those of cure group.27cases’s etiologies were EV71and EVU mixed infection.In the cure group,echocardiography showedabnormal in1cases(12.5%) and chest radiographs showed lungs exudativelesions in1cases(4.55%),while echocardiography showed abnormal in5cases(100%) and chest radiographs showed lungs exudative lesions in9cases(39.13%).The heart rate was screened out as an independent risk factorfor death in Logistic regression analysis.10survival cases remainedsequelae,4of them had performances of unsteady gait,3of them had hadperformances of tremble of limbs,startle,easy tumbling and1case got dysfunction of the left lower limb, left foot abduction deformityaccompanied by left lower limb muscle atrophy.Conclusion: Serious HFMD occurs mainly in male children under3years old, and the fever mainly presented hyperpyrexia andultrahyperpyrexia. The rashes occurred in multiple parts and presentedmulti-form, and the worse the prognosis was, the more atypical the rashcharacteristic was and the less the rashes were. The risk factors result indeath of serious HFMD include vomit, tremors, coma, cyanosis, hypoxemia,poor peripheral circulation, low blood pressure, respiratory rate, heat rate,respiratory system involvement and circulatory system involvement.Generally, the respiratory and circulatory system will mostly be involved inthe first5days and the earlier involvement time indicated the faster progressof disease and higher mortality. The white blood cells, blood sugar, CK-MB,AST, lung exudative lesions and echocardiography are associated with thedegree of severity level of disease to some extent.Serious HFMD may lead toflaccid paralysis that mainly presented paralysis of both lower limbs, andmay remain permanent paralysis and deformity. |
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