摘要目的:探讨小儿重症手足口的临床特征及其预后的影响因素。方法:抽取2015年1月至2020年12月开封市儿童医院收治的年龄1~3岁的手足口病患儿200例，采用跟踪随访的方式收集患儿临床资料，在完整收集资料的基础上自制患儿临床资料填写表，初步对比分析两组患儿一般资料(性别、年龄、发病至入院时间、病菌种类、白细胞指标、空腹血糖以及临床体征等)，总结出重症手足口病患儿的临床特征以及预后结局，根据预后结局将患儿分为预后不良组与预后良好组。比较两组基线资料，将差异有统计学意义的相关因子代入Logistic进行回归性分析，解析出重症手足口患儿影响不良结局的相关因素。结果:随访结果显示，重症患儿的临床特征为意识淡漠、昏迷、恶心呕吐、呼吸急促或呼吸困难、长久高热、心率明显加快、血压升高，患儿体征表现为四肢肢端冰冷、皮肤发花、口唇发绀、皮疹等。预后不良组患儿20例，预后良好组患儿180例，重症手足口病患儿预后不良的发生率为10%(20/200)。对比分析相关资料，结果显示，两组患儿性别、年龄、昏迷情况、发病至入院时间比较差异未见统计学意义( P>0.05)，两组患儿肠道病毒71型(EV71)感染、白细胞计数、空腹血糖、循环障碍比较差异有统计学意义( P<0.05)，经Logistic回归性检验，证明EV71感染、白细胞计数、空腹血糖以及循环障碍是影响重症手足口患儿预后结局的相关因素。 结论:重症手足口临床特征复杂多变，多表现为发热、恶心呕吐、心率明显加快、血压升高等；EV71感染、白细胞计数、空腹血糖以及循环障碍是影响患儿结局的相关因素，且均为危险因素。所以在临床治疗中出现以上因素的患儿，需严密监控病情发展情况，以进行及时有效的治疗，降低预后不良的发生率。

abstractsObjective:To investigate the clinical characteristics of severe hand, foot and mouth disease in children, and the influencing factors of their prognosis.Methods:A total of 200 children with hand, foot and mouth disease aged 1 to 3 years who were admitted to Kaifeng Children’s Hospital from January 2015 to December 2020 were selected. The clinical data of the children were collected by follow-up. On the basis of the complete collection of data, the patient’s clinical data fill-in form was prepared, and the general data of the two groups of children, such as gender, age, time from onset to admission, bacterial species, white blood cell index, fasting blood glucose and clinical signs, were preliminarily compared and analyzed. The clinical characteristics and prognosis of children with severe hand, foot and mouth disease were summarized, and the children were divided into a poor prognosis group and a good prognosis group according to the prognosis results. The baseline data of the two groups were compared, and then the relevant factors with statistically significant differences were substituted into Logistic for regression analysis. And the relevant factors affecting the adverse outcomes of children with severe hand, foot and mouth were analyzed.Results:Follow-up results showed that the clinical features of critically ill children were apathy, coma, nausea and vomiting, shortness of breath or dyspnea, prolonged high fever, markedly increased heart rate, and elevated blood pressure. The physical signs included cold diatal limbs, mottled skin, blue lips and rash. There were 20 children in the poor prognosis group and 180 children in the good prognosis group. The incidence of poor prognosis in children with severe hand, foot and mouth disease was 10% (20/200). Results of comparative analysis of relevant data showed that there was no significant difference in gender, age, coma, and time from onset to admission between the two groups ( P>0.05). There were significant differences in enterovirus 71 (EV71) infection, white blood cell count, fasting blood glucose, and circulatory disturbance between the two groups ( P<0.05). Results of Logistic regression test proved that EV71 infection, white blood cell count, fasting blood glucose and circulatory disturbance were related factors affecting the prognosis of children with severe hand, foot and mouth disease. Conclusions:The clinical features of severe hand, foot and mouth disease are complex and changeable, most of patients manifested fever, nausea and vomiting, markedly increased heart rate, and elevated blood pressure. EV71 infection, white blood cell count, fasting blood glucose, and circulatory disturbance are associated with the outcome of children, and they are all risk factors. Therefore, in the clinical treatment of children with the above factors, it is necessary to closely monitor the development of the disease in order to carry out timely and effective treatment and reduce the incidence of poor prognosis.