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目的探讨重症手足口病(HFMD)并发神经源性肺水肿(NPE)的主要危险因素,为其早期识别、及时治疗提供参考依据。方法应用Meta分析对国内外1990-2014年关于重症HFMD并发NPE危险因素的研究文献进行综合分析,经异质性检验,分别采用固定效应模型和随机效应模型进行相对危险度(OR值)合并,计算其95%可信区间(95%CI),并进行敏感性分析及发表偏倚评估,筛选重症HFMD并发NPE的危险因素。结果共纳入研究文献14篇,病例(重症HFMD并发NPE,NPE)568例,对照(重症HFMD)1321例。NPE危险因素的合并OR值及95%CI分别为:嗜睡3.12(1.94~5.00)、呕吐3.85(2.04~7.25)、肢体震颤8.12(2.33~28.33)、不典型皮疹5.44(3.35~8.84)、血压增高或降低7.56(3.25~17.57)、心动过速16.33(8.55~31.20)、毛细血管充盈时间(CRT>5s)6.22(2.87~13.50)、呼吸节律改变19.10(4.74~76.90)、高血糖(≥8.30 mmol/L)8.25(4.26~15.95)。结论皮疹不典型的重症HFMD患儿出现嗜睡、呕吐、心动过速、毛细血管充盈时间延长、血压增高或降低、呼吸节律改变以及血糖增高是NPE发生的危险因素。
Objective To explore the main risk factors of severe neurophobe (HFMD) complicated with neurogenic pulmonary edema (NPE), and to provide a reference for its early identification and timely treatment. Methods Meta-analysis was used to analyze the literature about the risk factors of NPE complicated with severe HFMD from 1990 to 2014 both at home and abroad. According to heterogeneity test, fixed risk model and random effects model were used to analyze the relative risk (OR) The 95% confidence interval (95% CI) was calculated, and sensitivity analysis and published bias assessment were performed to screen for risk factors for severe HFMD complicated with NPE. Results A total of 14 articles were included in the study, including 568 cases of severe HFMD complicated with NPE and 1321 cases of severe HFMD. The combined odds ratio (OR) and 95% CI of risk factors for NPE were as follows: lethargy 3.12 (1.94-5.00), vomiting 3.85 (2.04-7.25), limb tremor 8.12 (2.33-28.33), atypical skin rash 5.44 (3.35-8.84) (7.56 ~ 3.25 ~ 17.57), tachycardia (16.33 ~ 8.55 ~ 31.20), capillary filling time (6.22 ~ 2.50 ~ 31.50), respiratory rhythm change (19.74 ~ 76.90), hyperglycemia 8.30 mmol / L) 8.25 (4.26 ~ 15.95). Conclusion Children with atopic dermatitis and severe HFMD may be drowsiness, vomiting, tachycardia, prolongation of capillary filling, increase or decrease of blood pressure, change of respiratory rhythm and hyperglycemia are risk factors of NPE.