Abstract:

Objective To discuss the prognostic value of noninvasive hemodynamic monitoring index on children with severe hand, foot and mouth disease. Methods The children who were admitted to the PICU of Hunan children's hospital and receiving noninvasive cardiac monitoring from April 1st, 2014 to December 1st, 2014 for hand, foot and mouth disease were collected in our study. They were divided into general cases subgroups, severe subgroups and critical subgroups according to the illness severity; and divided into survival group and death group according to the prognosis. In the same period in the hospital the gender matched cases with normal cardiac function were as control group. Fifteen indicators including conventional parameters, pump function, after the load, the myocardial contraction force and thoracic fluid level were monitored by ICON noninvasive cardiac output measurement instrument in two groups. The differences of the control group and hand, foot and mouth disease groups were analyzed, the factors significant to the single analysis were further analyzed with multiariable logistic regression analysis, the ROC curves were made for the indexes, and calculated the optimal boundary value and its sensitivity, specificity, positive predictive value and negative predictive value. Results During the study period 95 cases of children with hand, foot and mouth disease were included, male 62 cases, aged 6 months to 8 years; 31 in general cases subgroups, 42 in severe subgroups and 22 in critical subgroups, 81 in survival group and 14 in death group. Control group included 48 cases, male 30 cases, aged 4 months to 7 years. There was no statistically significant difference in gender, age distribution between two groups. ① Comparing the control group, general cases subgroups, severe subgroups and critical subgroups, the levels of CO, CI, SV, SI, SVR, SVRI, SVV, PEP, LVET, EF, STR, TFC were significantly different(P<0.05). ② The levels of STR, SVR, SVRI, PEP and TFC in the death group were significantly higher than those in the survival group. Meanwhile the levels of CO, CI, SV, SI, SVV, LVET and EF were obviously lower than those in the survival group (P<0.05). ③ The Logistic regression analysis showed CI and SVV were death protective factors, OR was 0.568 and 0.637 respectively，SVR、PEP、STR、TFC were death protection factors in children with severe hand, foot and mouth disease，OR was 2.003（95%CI 1.929-4.008）,2.040（95%CI 1.935-4.157）,1.011（95%CI 1.040-1.881） and 1.979（95%CI 1.087-3.011）,respectively. ④ CI index area under the receiver-operating characteristic curve was 0.792. CI 2.0 L·min-1·m-2 for predicting the sensitivity of the death and specific degrees was 64.2%和80.2% respectively. Conclusion Noninvasive hemodynamic monitoring was valuable in the treatment of children with severe hand, foot and mouth disease. SVR、PEP、STR、TFC were death protective factors in children with severe hand, foot and mouth disease.