手足口病重癥病例診療狀況評(píng)估
發(fā)布時(shí)間：2018-08-19 13:05
【摘要】：研究背景2010年衛(wèi)生部對(duì)《手足口病診療指南(2008年版)》進(jìn)行修訂后頒發(fā)了《手足口病診療指南(2010年版)》,以規(guī)范手足口病的診斷和治療。2010年3月,世界衛(wèi)生組織(WHO)制定了《手足口病臨床管理和公共衛(wèi)生應(yīng)對(duì)指南》。為更好地了解我國(guó)手足口病重癥病例現(xiàn)行診斷和治療狀況,特在全國(guó)部分地區(qū)開(kāi)展手足口病重癥病例診療狀況評(píng)估。 研究目的掌握全國(guó)傳染病疫情報(bào)告系統(tǒng)手足口病重癥病例診斷的狀況,并為進(jìn)一步完善我國(guó)手足口病重癥病例報(bào)告標(biāo)準(zhǔn)、評(píng)估手足口病疾病負(fù)擔(dān)提供參考依據(jù)。 研究方法選擇2011年1-5月報(bào)告手足口病重癥病例數(shù)前五位的河南、山東、浙江、四川、云南等五個(gè)省份為研究地區(qū),運(yùn)用系統(tǒng)抽樣方法,隨機(jī)抽取15個(gè)地市、32家醫(yī)院通過(guò)傳染病報(bào)告信息系統(tǒng)所報(bào)告的手足口病重癥病例為調(diào)查對(duì)象,采用現(xiàn)場(chǎng)查看住院手足口病重癥病例病案,用統(tǒng)一調(diào)查表提取病例臨床表現(xiàn)、用藥情況及疾病診斷等情況,并對(duì)主治醫(yī)生進(jìn)行訪談等方式,收集手足口病重癥病例的臨床特征和治療等信息。對(duì)收集的臨床特征及診斷分類情況進(jìn)行描述性分析,并與我國(guó)手足口病診斷標(biāo)準(zhǔn)及WHO的有關(guān)指南的符合程度進(jìn)行比較。 研究結(jié)果(1)診斷狀況評(píng)估：依據(jù)國(guó)內(nèi)標(biāo)準(zhǔn),臨床診斷重癥病例中97%符合國(guó)內(nèi)重癥病例診斷標(biāo)準(zhǔn),3%病例符合普通型病例診斷標(biāo)準(zhǔn)。實(shí)驗(yàn)室確診病例中,97.5%符合國(guó)內(nèi)重癥病例診斷標(biāo)準(zhǔn),2.5%病例符合普通型病例診斷標(biāo)準(zhǔn)。依據(jù)WHO標(biāo)準(zhǔn),臨床診斷重癥病例中86%符合WHO手足口病并發(fā)癥診斷標(biāo)準(zhǔn),14%病例僅符合輕癥病例診斷標(biāo)準(zhǔn)。實(shí)驗(yàn)室確診病例中91%符合WHO手足口病并發(fā)癥診斷標(biāo)準(zhǔn),9%病例僅符合輕癥病例診斷標(biāo)準(zhǔn)。針對(duì)國(guó)內(nèi)《手足口病診療指南》(2010版)標(biāo)準(zhǔn)和WHO推薦《指南》標(biāo)準(zhǔn)進(jìn)行一致性檢驗(yàn)。結(jié)果顯示：兩種標(biāo)準(zhǔn)對(duì)重癥病例診斷一致性弱(Kappa系數(shù)為0.027)。 (2)重點(diǎn)治療藥物使用狀況評(píng)估：國(guó)內(nèi)標(biāo)準(zhǔn)診斷的普通病例和重癥病例中,糖皮質(zhì)激素類藥物使用率分別為90%和95%,抗病毒藥物使用率分別為90%和77%,抗生素使用率分別為80%和87%,免疫制劑使用率分別為75%和63%,退熱鎮(zhèn)痛類藥物使用率均為45%,血管活性藥物使用率分別為15%和17%,兩類病例的藥物使用無(wú)統(tǒng)計(jì)學(xué)差異；脫水降壓類藥物使用率分別為70%和92%(P=0.001),中草藥類藥物使用率分別為55%和78%(P=0.01),止驚鎮(zhèn)靜類藥物使用率分別為5%和25%(P=0.04),兩類病例的藥物使用有統(tǒng)計(jì)學(xué)差異。WHO標(biāo)準(zhǔn)診斷的EV71病例中輕癥病例和并發(fā)癥病例抗生素,中草藥類藥物和糖皮質(zhì)激素類藥物的使用情況無(wú)統(tǒng)計(jì)學(xué)差異,其他藥物的使用有統(tǒng)計(jì)學(xué)差異。 (3)機(jī)械通氣使用狀況評(píng)估：依據(jù)國(guó)內(nèi)標(biāo)準(zhǔn)診斷的普通病例均未使用機(jī)械通氣,重癥病例使用機(jī)械通氣率為21%。依據(jù)WHO標(biāo)準(zhǔn)診斷的輕癥病例和并發(fā)癥病例中,1.4%輕癥病例實(shí)施機(jī)械通氣,2.7%神經(jīng)系統(tǒng)受累病例實(shí)施機(jī)械通氣,29%早期心肺衰竭病例實(shí)施機(jī)械通氣,83%晚期心肺衰竭病例實(shí)施機(jī)械通氣。 研究結(jié)論(1)手足口病重癥病例基本符合我國(guó)手足口病重癥病例和WHO并發(fā)癥診斷標(biāo)準(zhǔn),但少數(shù)病例符合普通型診斷標(biāo)準(zhǔn)。(2)我國(guó)《手足口病診療指南》(2010版)標(biāo)準(zhǔn)和WHO推薦的《手足口病臨床管理和公共衛(wèi)生應(yīng)對(duì)指南》兩種標(biāo)準(zhǔn)在重癥病例診斷方面,存在不一致性,我國(guó)診療指南的敏感性較高。(3)國(guó)內(nèi)和WHO指南中提倡的免疫制劑、退熱鎮(zhèn)痛類藥物、血管活性藥物和止驚鎮(zhèn)靜類藥物使用比例不高,而不推薦使用或有適條件的的糖皮質(zhì)激素類藥物,抗生素的使用占較大比例。(4)機(jī)械通氣使用指征未能按照國(guó)內(nèi)標(biāo)準(zhǔn)和WHO提倡標(biāo)準(zhǔn)執(zhí)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.
【學(xué)位授予單位】：中國(guó)疾病預(yù)防控制中心
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R725.1
本文編號(hào)：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.
【學(xué)位授予單位】：中國(guó)疾病預(yù)防控制中心
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R725.1
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