The Clinical Study Of Mechanical Ventilation On The Severe Cases Of Hand Foot And Mouth Disease

Objective:This study aimed to examine the effects of different timings of mechanical ventilation therapy on the clinical efficacy of severe hand,foot and mouth disease,and to analyze its epidemiological characteristics.Methods:From April 2010 to September 2017,at our hospital of the Children's Intensive Care Unit?Hand,Foot and Mouth Disease Area?,we selected 129 cases of severe hand,foot and mouth disease?stage 3?hospitalized retrospectively.Exclude the cases were incomplete or combined with other diseases.There were totally included118 cases.?1?The clinical data were collected and counted for epidemiological analysis;?2?According to the timing of mechanical ventilation treatment,they were divided into two groups,A and B.There were 68 cases in group A and 50 cases in group B.Group A is the first?3?in accordance with the indications for mechanical ventilation,that is,cases with respiratory rhythm changes?apnea,double inhalation,sobbing or sigh-like breathing 3 times/10 min and above?,combined with the other therapy;Group B is in accordance with the indications for mechanical ventilation treatment?3?,due to family refusal and other reasons for not on-machine treatment,first give the other therapy,in accordance with the indications of mechanical ventilation?1?frequent convulsions,limb shaking or tremor;?2?nystagmus,binocular gaze or upturned eyes;?4?breathing that does not match body temperature,increased heart rate,and secretions in the airway;?5?short-term wetness in the lungs or exudative changes in the chest radiograph;?6?pale,pale or bun;?7?poor peripheral circulation,cold sweat,sudden drop in blood pressure Cases on the machine again;family members of both groups signed a mechanical ventilation treatment consent form,and the other treatment plans given by the two groups were consistent.Collect and statistically observe indicators such as gender,age,virus type,heart rate,blood pressure,blood gas index,blood glucose,white blood cell?WBC?,liver enzyme?ALT,alanine aminotransferase;AST,aspartate aminotransferase?,myocardium Enzyme?CK-MB,creatine kinase isoenzyme?,length of hospital stay,daily average hospitalization cost,time taken,mortality,incidence of ventilator-related complications.Results:?1?Epidemiological characteristics:Among 118 cases,82 males and 36females,the ratio of male to female was 2.27:1.The incidence of severe hand,foot and mouth disease was higher in boys than in girls;the average age was?1.82±1.34?years old,The severe cases was mainly occurred in children under 3 years of age,focused on the 1 year old group and the 2 year old group.There are many severe cases of scattered children,followed by children in kindergartens and school-age children.The incidence of rural children is higher than that of towns and cities.The high-incidence period is concentrated in May-August and the most in July.Compared with the virus detection rate,102 cases were positive,accounting for 86.44%,of which EV-A71 accounted for81.37%,CoX-A16 accounted for 6.86%,and others accounted for 11.76%.08.82)Yuan,group A was less than group B,the difference was statistically significant?P<0.05?.?2?The effect of mechanical ventilation on the clinical efficacy of severe hand,foot and mouth disease:there was no significant difference in gender,age,virus type,heart rate,blood pressure and blood gas index,white blood cell?WBC?,blood glucose,liver enzyme?ALT,alanine aminotransferase;AST,aspartate aminotransferase?and myocardial enzyme?CK-MB,creatine kinase isoenzyme?between the two groups?P>0.05?.The PEEP values of group A and group B were?4.59±0.50?cmH₂O and?7.68±1.28?cmH₂O,respectively.The PIP values were?14.59±1.50?cmH₂O and?26.00±2.06?cmH₂O,respectively,and FiO2 was?30.00±0.98?%and?48.00±2.33?%,all indicators in group A were lower than group B,and there was significant difference between them?P<0.05?.The belting time of group A and group B was?91.21±18.67?h and?125.52±27.43?h,respectively.The time of group A was shorter than that of group B,and there was significant difference between them?P<0.05?.There was no significant difference in the incidence of ventilator-associated pneumonia,pneumothorax,mediastinal emphysema and subcutaneous emphysema between the two groups?P>0.05?.The hospitalization days in group A and group B were?10.06±1.87?days and?15.44±1.80?days,respectively,and there was a significant difference between the two groups?P<0.05?.The mortality of group A?8.3%?was lower than that of group B?36.6%?,and there was a significant difference between the two groups?P<0.05?.The average daily hospitalization expenses of group A and group B were?1230.32±64.41?yuan and?2390.51±108.82?yuan,respectively,and group A was less than group B,the difference was statistically significant?P<0.05?.Conclusion:?1?Boys under 3 years old,living in rural areas,scattered children had more severe hand,foot and mouth disease,it is recommended to strengthen the knowledge and publicity and improve the living environment during the period of high incidence of severe hand,foot and mouth disease from May to August;?2?When the child has a change in respiratory rhythm?apnea,double inhalation,sobbing or sigh-like breathing 3 times/10 min and above?,immediate application of mechanical ventilation therapy can reduce the time of the belt and does not increase ventilator-related complications and may be helpful to reduce lung damage and delay the progression of the disease.It can reduce mortality,shorten hospital stays,and reduce daily hospitalization costs.