Analysis Of High Risk Factors Of Mechanical Ventilation And Death In Critical Hand,Foot And Mouth Disease

Objective:This study was designed to investigate the risk factors of mechanical ventilation and death in children with critical hand,foot and mouth disease(HFMD).Method:The children with critical HFMD admitted to the first affilated hospital of USC from April 2016 to May 2018 were selected as subjects.According to the severity of the disease and whether need immediate respiratory support with mechanical ventilation and final result,the subjects were divided into 4 groups:V group:Children were diagnosed as critical HFMD when admitted to hospital,and need mechanical ventilation.NV group:Children were diagnosed as critical HFMD when admitted to hospital,and not treated with mechanical ventilation;S group:Children were diagnosed as critical HFMD and were treated with mechanical ventilation and final had survived.D group:Children were diagnosed as critical HFMD and were treated with mechanical ventilation,but developed to death.The general situation,clinical manifestations and laboratory test results were summarized and statistically analyzed.The mean was analyzed by t-test and one-way analysis of variance.The chi-square test was used to classify the data.The general conditions,clinical manifestations and laboratory of each group were compared to differences in examination results,logistic regression analysis of meaningful factors to identify mechanical ventilation and death risk factors in critical cases.RESULTS:A total of 81 children were selected into the study,including 51 in the V group,30 in the NV group,31 in the S group,20 in the D group.1.Univariate analysis results:V group compared with NV group:The differences of age,gender,time of visit,admission department,heart rate,blood pressure,convulsions,startle,vomiting,bloating,disturbance of consciousness,meningeal irritation,creatine kinase(CK),Serum creatinine,white blood cell(WBC),neutrophil ratio(N),lymphocyte ratio(L),hemoglobin(Hb),platelet(PLT),bicarbonate ion(HCO3~-),blood glucose level,base excess(BE),brain natriuretic peptide(BNP),C-reactive protein(CRP),blood lactate(LAC),procalcitonin(PCT),and coxsackie virus levels had no statistically significance(P>0.05).The differences of fever,jitter,myoclonus,apnea,increase in creatine kinase isoenzyme(CK-MB),bicarbonate ion(HCO3~-)anomaly,increase in hypersensitive troponin(cTnT),pH decline,enterovirus 71(Ev71)infection and enterovirus universal type infection had statistically significance(P<0.05).S group compared with D group:The differences of age,sex,time of visit,time of intubation,heart rate,blood pressure,convulsions,startle,jitter,vomiting,bloating,disturbance of consciousness,apnea,meningeal irritation,CK,CK-MB,serum creatinine,WBC,N,L,Hb,PLT,HCO3~-,blood glucose level,BE,CRP,PCT,enterovirus 71(EV71),coxsackie virus levels had no statistically significance(P>0.05).The differences of admission(non-paediatric intensive care unit),fever,myoclonus,increase in BNP,increase in cTnT,PH decline,increase in LAC and enterovirus universal type infection had statistically significance(P<0.05).2.Multi-factor logistic regression analysis:The regression equation for the risk factors of mechanical ventilation in children withcriticalHFMDislogitP=-7.767+1.405X1+3.073X3+1.450X5+1.921X6+1.839X8+3.712X11.Among themΧ1、Χ3、Χ4、X5、Χ8、X11 represent hyperthermia,jitter,apnea,myoclonus,increase in cTnT,EV71 infection respectively;the regression equation for the risk factors of death after mechanical ventilation of children with critical HFMD is logitP=-6.659+1.827X1+13.67X2+2.833X3+1.58X5+1.322X6+1.712X9.Among themΧ1、Χ2、Χ3、X5、Χ6、X9 represent admission(non-paediatric intensive care unit),hyperthermia,ultrahyperpyrexia,increase in BNP,increase in cTnT,increase in LAC respectively.Conclusion:1.Hyperthermia,jitter,apnea,myoclonus,increase in cTnT,EV71infection are risk factors for mechanical ventilation in children with critical HFMD;2.Admission(non-paediatric intensive care unit),hyperthermia,ultrahyperpyrexia,increase in BNP,increase in cTnT and increase in LAC are risk factors for death in children with critical HFMD.