本文選題：腸道病毒71型 + 小兒病毒性腦炎�。� 參考：《青島大學》2017年碩士論文

【摘要】：目的調查腸道病毒71型小兒腦炎重癥的發(fā)生情況。通過分析普通組、重癥組患兒臨床特點,探討初期引起重癥病例的危險因素。為早期識別重癥腸道病毒71型小兒腦炎、制定合理的診療計劃,降低致殘率提供臨床依據。提高護士對重癥腸道病毒71型小兒腦炎初期臨床特點的認識,確立簡單的病情評估標準,及時發(fā)現病情變化、有效干預。方法本研究采用回顧性研究方法。根據病毒核酸經反轉錄聚合酶鏈反應(RT-PCR)檢測結果,使用自行設計的調查表收集2014年12月-2016年11月在青島大學附屬醫(yī)院、青島市婦女兒童醫(yī)院兒內科首次確診為腸道病毒71型小兒腦炎入院72h內相關資料。比較普通組、重癥組在一般資料、臨床表現、體征及實驗室指標等方面的差異。有意義影響因素(P0.05)納入Logistic回歸分析。結果本研究共搜集腸道病毒71型小兒腦炎重癥組62例、普通組125例。187例入院患者重癥發(fā)生率33.16%(62/187)。1.一般資料方面:重癥腸道病毒71型小兒腦炎的發(fā)生率男性高于女性,農村高于城鎮(zhèn),與普通病例相比差異具有統(tǒng)計學意義(P0.05)。重癥EV71型小兒腦炎患病年齡集中在3歲及以下。2.臨床表現、體征方面:腸道病毒71型小兒腦炎重癥組初期嘔吐、驚厥、肢體抖動、病理征陽性、腦電圖異常的發(fā)生率較普通組差異有統(tǒng)計學意義(P0.05)。重癥組腸道病毒71型小兒腦炎初期腋溫大于38℃持續(xù)時間(h)及腋下最高體溫(℃)與普通組相比具有顯著性差異(P0.05)。3.實驗室檢查方面:重癥組腸道病毒71型小兒腦炎初期白細胞計數、中性粒細胞計數、淋巴細胞計數、空腹血糖、肌酸激酶同工酶相比普通組差異具有統(tǒng)計學意義(P0.05)。4.Logistic回歸結果:腋溫大于38℃持續(xù)時間(h)(OR=1.084,95%CI:1.040~1.131)、肢體抖動(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)、白細胞計數升高(OR=1.449,95%CI:1.232~1.704)是重癥EV71型小兒腦炎初期的危險因素。結論1.重癥腸道病毒71型小兒腦炎初期癥狀和體征包括:嘔吐、驚厥、肢體抖動、病理征陽性、腦電圖異常、腋溫大于38℃持續(xù)時間(h)較長及腋下最高體溫(℃)較高,中性粒細胞計數、白細胞計數、肌酸激酶同工酶、空腹血糖明顯升高。2.護士應加強對初期出現肢體抖動、病理征陽性,空腹血糖、白細胞計數明顯升高,持續(xù)高熱不退的低齡患兒的評估和監(jiān)護,及時干預,減少重癥發(fā)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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