狂犬病暴露患儿狂犬病人免疫球蛋白的使用现状及相关因素分析 点击下载
| 论文标题： | 狂犬病暴露患儿狂犬病人免疫球蛋白的使用现状及相关因素分析 |
| 英文标题： | |
| 中文摘要： | 目的 分析狂犬病暴露患儿狂犬病人免疫球蛋白（HRIG）的使用现状及相关因素，为HRIG的合理使用提供依据。方法回顾性收集2024年1－12月于厦门市儿童医院门急诊就诊的狂犬病暴露患儿的资料，分析患儿的HRIG使用情况，采用单因素、多因素Logistic回归分析影响患儿应使用HRIG但未使用的独立危险因素。采用问卷调查法评价42名外科医师对狂犬病暴露后预防处置知识的掌握情况、影响HRIG使用的自评因素以及高危暴露情景下患儿未使用HRIG的原因。结果共纳入564例患儿，其中122例符合HRIG使用指征，仅24例实际使用，实际使用率为19.67%。多因素Logistic回归分析显示，头面部暴露是患儿应使用HRIG但未使用的独立危险因素[OR＝7.77，95%CI（1.11，54.27），P＝0.039]。问卷调查结果显示，外科医师对狂犬病疫苗接种后抗体产生时间的知晓率（35.71%）最低，其次为HRIG使用时机（50.00%）；外科医师对影响HRIG使用的自评因素以伤口深度与出血情况的平均分（2.95分）最高；特例和Ⅲ级暴露患儿未使用HRIG的主要原因均为判断致伤动物健康/风险较低（占比分别为45.24%、38.10%）；其次为家长因费用、疼痛等原因明确拒绝（占比分别为26.19%、33.33%）。结论我院符合HRIG使用指征患儿的HRIG实际使用率较低，头面部暴露是患儿应使用HRIG但未使用的独立危险因素。部分外科医师对狂犬病疫苗接种后抗体产生时间及HRIG使用时机掌握不足，动物风险判断和家长意愿可能影响HRIG的使用。 |
| 英文摘要： | OBJECTIVE To analyze the current status and associated factors of human rabies immunoglobulin （HRIG） use in children with rabies-exposure， so as to provide a reference for the rational use of HRIG.METHODS Clinical data of children with rabies-exposure who were admitted to the outpatient and emergency departments of Xiamen Children’s Hospital from January to December 2024 were retrospectively collected. HRIG use in these children was analyzed， and univariate and multivariate Logistic regression analyses was used to identify independent risk factors for non-use of HRIG among children indicated for it.A questionnaire survey was conducted to assess 42 surgeons’ knowledge of rabies-post-exposure prophylaxis，self-rated factors influencing HRIG use，and reasons for non-use in high-risk exposure scenarios.RESULTS A total of 564 pediatric patients were enrolled， of whom 122 met the indications for HRIG use； however， only 24 received HRIG， yielding an actual utilization rate of 19.67%. Multivariate Logistic regression analysis showed that head and facial exposure was an independent risk factor for non-use of HRIG [OR＝7.77， 95%CI （1.11， 54.27）， P ＝0.039]. The questionnaire survey revealed that surgeons had the lowest awareness rate regarding the time to antibody production after rabies vaccination （35.71%）， followed by the appropriate timing of HRIG administration （50.00%）. Among the self-rated factors influencing HRIG use by surgeons， wound depth and bleeding status had the highest mean scores （2.95 points）. The primary reasons for non-use HRIG in special cases and grade Ⅲ exposure pediatric patients were the judgment that the offending animal was healthy or posed low risk，accounting for 45.24% and 38.10%， respectively； followed by parental refusal due to cost， pain， or other concerns，accounting for 26.19% and 33.33%， respectively.CONCLUSIONS The actual utilization rate of HRIG among children meeting the indications for HRIG use in our hospital was relatively low. Head and facial exposure was an independent risk factor for non-use of HRIG. Some surgeons had insufficient understanding of the time to antibody production after rabies vaccination and the appropriate timing of HRIG administration. Animal-related risk assessment and parental preferences may influence the use of HRIG. |
| 期刊： | 2026年第37卷第16期 |
| 作者： | 林金香；陈丽；柯惠超；李苏平；陈钰霜；张清池 |
| 英文作者： | LIN Jinxiang，CHEN Li，KE Huichao，LI Suping，CHEN Yushuang，ZHANG Qingchi |
| 关键字： | 狂犬病人免疫球蛋白；狂犬病；被动免疫；儿童；头面部暴露；影响因素 |
| KEYWORDS： | human rabies immunoglobulin;rabies;passive immunization;Children;head and face exposure;Influencing factors |
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