發(fā)布時(shí)間：2018-06-18 12:15

  本文選題：手足口病 + 重癥病例　； 參考：《第三軍醫(yī)大學(xué)》2016年碩士論文

【摘要】：手足口病(Hand-foot-mouth disease,HFMD)是一種全球性的傳染病,近年來(lái),手足口病的發(fā)病率在中國(guó)及亞太地區(qū)的不同國(guó)家呈逐步上升的趨勢(shì),同時(shí),還有較多重癥和死亡病例報(bào)告,給社會(huì)及家庭帶來(lái)極大的影響。在我國(guó),手足口病已于2008年5月被納入法定丙類傳染病報(bào)告管理。我國(guó)手足口病主要是以嬰幼兒最為易感,多發(fā)于4月-9月,主要表現(xiàn)為手、足、口腔等處出現(xiàn)皮疹或皰疹,對(duì)大部分病情較輕的患兒來(lái)說(shuō)都可以治愈,但若處理不合理或不及時(shí)可能導(dǎo)致一部分病情嚴(yán)重的患兒出現(xiàn)無(wú)菌性腦膜炎、心肌炎、肺出血等并發(fā)癥,甚至出現(xiàn)死亡。引起手足口病的病原體是腸道病毒,而且腸道病毒的種類較多,在中國(guó),手足口病病原體中以腸道病毒71型(EV71)和柯薩奇病毒A16型(Cox A16)最多,且重癥及死亡病例多由EV71感染引起。手足口病的傳染源包括病例和隱性感染者,其傳播的途徑及方式相對(duì)較多。由于手足口病傳染性強(qiáng)、傳播途徑復(fù)雜、兒童普遍易感,所以控制難度大。研究目的1.了解重慶市手足口病病例及其家庭的一般特征;手足口病病例的發(fā)病、診療情況;既往史及其他相關(guān)信息情況;樣本采集及實(shí)驗(yàn)室檢查情況;臨床癥狀、體征及并發(fā)癥的總體分布情況。2.了解重慶市手足口病重癥病例與輕癥病例之間、重癥死亡病例與重癥非死亡病例之間上述5方面特征的分布差異。3.探討重慶市兒童重癥手足口病病例的影響因素,以及重癥手足口病病例發(fā)生死亡的影響因素,為今后征對(duì)性開(kāi)展干預(yù)工作,降低重癥病例的發(fā)病率和病死率提供參考。對(duì)象與方法收集2011年—2014年重慶市(樣本來(lái)源于重慶市兒童醫(yī)院)90例重癥手足口病和90例輕癥手足口病病例,重癥病例包括52例重癥非死亡病例及38例重癥死亡病例,進(jìn)行重癥與輕癥病例及重癥死亡與重癥非死亡病例的影響因素分析。采用一對(duì)一問(wèn)詢及查看就醫(yī)病案相結(jié)合的方式完成統(tǒng)一的調(diào)查表,調(diào)查內(nèi)容包括:手足口病病例及其家庭的一般特征;手足口病病例的發(fā)病、就診及診療情況;既往史及其他相關(guān)信息情況;樣本采集及實(shí)驗(yàn)室檢查情況;臨床癥狀、體征及并發(fā)癥的總體分布情況。資料應(yīng)用Epi Data 3.1軟件進(jìn)行錄入,建立數(shù)據(jù)庫(kù),使用SPSS 19.0軟件進(jìn)行描述性分析、單因素分析和多因素非條件logistic回歸分析。研究結(jié)果1.本次研究共調(diào)查180例手足口病病例,重癥、輕癥病例各90(50%)例,其中重癥病例中死亡38例(占重癥病例的42.2%);男性117(65.0%)例,女性63(35%)例;年齡范圍4個(gè)月~6歲,平均年齡1.64±1.22歲,其中,嬰幼兒(≤3歲)167例(占92.8%),學(xué)齡前期兒童(4~6歲)13例(占7.2%)。采集了172例病例的樣本,采集最多的樣本類型是糞便135例(78.5%),標(biāo)本中任一項(xiàng)檢測(cè)為陽(yáng)性的有140例,陽(yáng)性率81.40%,其中病毒類型最多的為EV71有85例,檢出率為49.71%。2.調(diào)查對(duì)象發(fā)病與初次就診時(shí)間間隔都較短,平均都在1天以內(nèi);初次就診與確診的時(shí)間間隔平均接近2天。65.6%的調(diào)查對(duì)象初診醫(yī)院類型是縣級(jí)及以下級(jí)別的醫(yī)療機(jī)構(gòu),有62.2%的病例初診漏診手足口病,84.4%的病例首次確診手足口病是在市級(jí)及以上醫(yī)院�？h級(jí)及以下醫(yī)療機(jī)構(gòu)對(duì)手足口病的漏診率較高,為68.67%,隨著醫(yī)院級(jí)別升高,對(duì)手足口病的漏診率逐漸降低。3.調(diào)查對(duì)象中有168例(93.33%)有發(fā)熱癥狀,有58例(32.22%)出現(xiàn)咳嗽癥狀,有175例(97.22%)有出疹癥狀,疹子類型最多的是丘疹和皰疹,分別有141例(78.33%)和106例(58.89%)病例出現(xiàn),出疹部位最多的是出現(xiàn)在手、足部,均占85%以上。4.被調(diào)查患兒并發(fā)癥及體征出現(xiàn)最多的是神經(jīng)系統(tǒng),其次是呼吸系統(tǒng),依次有98.3%、83.3%的患兒出現(xiàn)。神經(jīng)系統(tǒng)出現(xiàn)最多的并發(fā)癥及體征前3項(xiàng)為:瞳孔狀態(tài)異常(95.56%)、精神差(53.33%)、易驚(32.78%);呼吸系統(tǒng)出現(xiàn)最多的并發(fā)癥及體征前3項(xiàng)依次為:咽痛(38.89%)、咳嗽(25.00%)、口唇紫紺(25.00%);循環(huán)系統(tǒng)出現(xiàn)最多的并發(fā)癥及體征前3項(xiàng)依次為:心率加快(43.33%)、四肢發(fā)涼(20.00%)、面色/手/腳未端蒼白發(fā)灰(17.78%);消化系統(tǒng)出現(xiàn)的并發(fā)癥及體征主要為嘔吐(34.44%)。5.重癥手足口病與輕癥手足口病兩組間單因素分析發(fā)現(xiàn):病毒類型、戶口類型、現(xiàn)住址類型、照看人文化程度、初次就診醫(yī)院類型、初診是否確診手足口病、發(fā)病與初診間隔時(shí)間、初診與確診間隔時(shí)間、是否發(fā)熱、最高溫超39℃、是否出疹、出疹持續(xù)時(shí)間、出現(xiàn)消化系統(tǒng)并發(fā)癥、出現(xiàn)循環(huán)系統(tǒng)并發(fā)癥等在兩組間的分布有統(tǒng)計(jì)學(xué)差異。6.重癥手足口死亡病例與重癥手足口非死亡病例兩組間單因素分析發(fā)現(xiàn):性別、戶口類型、發(fā)病季節(jié)、家庭14歲以下兒童數(shù)、初次就診的醫(yī)院類型、發(fā)熱癥狀平均持續(xù)時(shí)間、出疹平均持續(xù)時(shí)間、咽峽部有皰疹或潰瘍、出現(xiàn)消化系統(tǒng)的并發(fā)癥、出現(xiàn)深昏迷、呼吸困難、指/趾或口唇發(fā)紺、脈搏減弱、出現(xiàn)嘔吐、咖啡色嘔吐物在兩組間的分布有統(tǒng)計(jì)學(xué)差異。7.多因素分析發(fā)現(xiàn),手足口病病例發(fā)生重癥的影響因素有現(xiàn)住地類型為農(nóng)村、初次就診未確診手足口病、感染的病毒類型為EV71、出現(xiàn)循環(huán)系統(tǒng)并發(fā)癥4個(gè)因素,均為OR值1。重癥手足口病病例發(fā)生死亡的影響因素有:家庭成員中14歲以下兒童數(shù)、發(fā)熱持續(xù)時(shí)間、出疹持續(xù)時(shí)間、出現(xiàn)深昏迷、出現(xiàn)嘔吐5個(gè)因素,前3個(gè)因素OR值1,后2個(gè)因素OR值1。結(jié)論通過(guò)對(duì)2011年—2014年重慶市180例手足口病病例的調(diào)查研究,得出以下結(jié)論:1.提高縣級(jí)及以下醫(yī)療機(jī)構(gòu)對(duì)手足口病診治能力,在手足口病的防控過(guò)程中顯得尤為重要,加強(qiáng)對(duì)縣級(jí)及以下醫(yī)療機(jī)構(gòu)的相關(guān)培訓(xùn)已迫在眉睫。2.要加強(qiáng)對(duì)農(nóng)村幼兒園及家庭的預(yù)防保健宣傳,當(dāng)發(fā)現(xiàn)兒童出現(xiàn)發(fā)熱和手、足、口腔部出疹癥狀時(shí),要高度重視,及時(shí)到醫(yī)院診治。3.提高醫(yī)療機(jī)構(gòu)對(duì)手足口病的確診能力,當(dāng)發(fā)現(xiàn)患兒感染病毒類型為EV71或者出現(xiàn)循環(huán)系統(tǒng)并發(fā)癥時(shí),及時(shí)對(duì)患兒進(jìn)行對(duì)癥治療,有助于降低重癥手足口病病例的發(fā)生率。4.提高重癥手足口病病例可能發(fā)生死亡的早期提示因素的識(shí)別能力,當(dāng)發(fā)現(xiàn)患兒出現(xiàn)昏迷及嘔吐癥狀時(shí),加強(qiáng)對(duì)患兒的密切觀察和護(hù)理治療,降低重癥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.
【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R725.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳迪;李衛(wèi)華;姜朕;;重癥手足口病早期預(yù)警指標(biāo)篩選及其預(yù)警價(jià)值[J];山東醫(yī)藥;2016年08期

2 翟立峰;李海霞;;手足口病流行病學(xué)特征分析及管理防治對(duì)策[J];中國(guó)衛(wèi)生產(chǎn)業(yè);2015年26期

3 周定輝;;手足口病患兒臨床特征及重癥危險(xiǎn)因素Logistic回歸分析[J];中外醫(yī)學(xué)研究;2016年05期

4 楊建平;;關(guān)于手足口病的最新研究進(jìn)展及預(yù)防策略解析[J];當(dāng)代醫(yī)學(xué);2016年04期

5 朱韓武;譚徽;李成華;劉愛(ài)平;謝群;付敏;段良松;;2010～2014年郴州市手足口病重癥和死亡病例的流行病學(xué)及病原學(xué)特征研究[J];中國(guó)現(xiàn)代醫(yī)學(xué)雜志;2015年35期

6 劉坤;王瑋瑩;;手足口病的流行與防治[J];世界最新醫(yī)學(xué)信息文摘;2015年36期

7 王力偉;;重癥手足口病的早期識(shí)別與治療[J];中外醫(yī)學(xué)研究;2015年36期

8 劉志學(xué);;我國(guó)率先研發(fā)的手足口病疫苗即將上市[J];中國(guó)醫(yī)藥導(dǎo)報(bào);2015年36期

9 肖雅瓊;饒炎紅;;江西省手足口病時(shí)空聚集性及流行特征研究[J];當(dāng)代醫(yī)學(xué);2015年35期

10 張世勇;王洋;鄭偉;韋繼學(xué);徐曉陽(yáng);;重慶市5歲以下手足口病患兒家長(zhǎng)相關(guān)知信行調(diào)查[J];中國(guó)健康教育;2015年09期

相關(guān)碩士學(xué)位論文 前1條

1 孫大鵬;山東省手足口病流行特征及重癥危險(xiǎn)因素分析[D];山東大學(xué);2011年

，

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