CAJ | 학술논문

目的了解儿童危重甲型H1N1流感合并急性呼吸窘迫综合征(ARDS)的临床特点,探讨救治措施.方法前瞻性观察上海交通大学附属儿童医院收治的3例危重甲型H1N1流感的临床表现、化验检查、诊断、治疗转归.结果实时RCT-PCR检测3例患者均为甲型H1N1流感感染.以发热、咳嗽起病,全身性炎症反应相对轻.病程4～6 d病情突然恶化,出现口唇发绀,呼吸急促.X线片显示双肺多叶渗出或弥漫性炎症阴影.入院时已发展为ARDS.采用奥司他韦,小潮气量(6 mL/kg)、适当高PEEP通气策略和相对保守液体等治疗,3例患儿中存活2例,死亡1例.结论儿童危重甲型H1N1流感患儿,突然咳嗽加重和呼吸急促时,应高度怀疑ARDS.及时氧疗及呼吸支持,保守液体管理,预防继发感染等可能是关键治疗措施.需要积累更多病例资料来明确危重甲型H1N1流感特征和评价救治手段.
목적 료해인동위중갑형H1N1류감합병급성호흡군박종합정(ARDS)적림상특점,탐토구치조시.방법 전첨성관찰상해교통대학부속인동의원수치적3례위중갑형H1N1류감적림상표현、화험검사、진단、치료전귀.결과 실시RCT-PCR검측3례환자균위갑형H1N1류감감염.이발열、해수기병,전신성염증반응상대경.병정4～6 d병정돌연악화,출현구진발감,호흡급촉.X선편현시쌍폐다협삼출혹미만성염증음영.입원시이발전위ARDS.채용오사타위,소조기량(6 mL/kg)、괄당고PEEP통기책략화상대보수액체등치료,3례환인중존활2례,사망1례.결론 인동위중갑형H1N1류감환인,돌연해수가중화호흡급촉시,응고도부의ARDS.급시양료급호흡지지,보수액체관리,예방계발감염등가능시관건치료조시.수요적루경다병례자료래명학위중갑형H1N1류감특정화평개구치수단.
Objective To describe the characteristics of and emergency treatment for and outcomes of critical ill children with 2009 influenza A caused by H1N1 virus strain. Method A prospective observational study of 3 pediatric patients with severe influenza A of H1N1 virus strain complicated with acute respiratory distress syndrome (ARDS) from November to December 2009. Results The H1N1 virus strain was confirmed by using realtime reverse transcription polymerase chain reaction (Real-time RT-PCR). Two patients survived and one died. Fever and cough were the onset symptoms. The systemic responses to influenza A at first were relatively mild. The tragic deterioration occurred all of a sudden with cyanosis all over the lips and dyspnea. The roentgenography showed bilateral multiple tabular pulmonary effusion and diffuse opaque shadows. The length of time required to confirm the diagnosis of ARDS from the symptom onset was 4 to 6 days. All patients were severely hypoxic with the ratio of PaO2 to 0.7-0.9 fraction of inspired oxygen (FiO2) to be 70- 100 mmHg at admission to PICU. In order to avoid injury to the lung, the protective ventilation strategy was carried out with low tidal volume (6 mL/kg) and adequate pressure,and conservative fluid management. Conclusions The H1N1 strain influenza virus A is characterized by pyrexia, cough and other respiratory symptoms in the early stage of critically ill children. In a few days, cough increased along with a sudden burst of cyanotic lips and shortness of breath, highly suggesting ARDS. Timely oxygen therapy and respiratory support, conservative fluid management, and the prophylaxis of secondary infection may be the essential measures. More clinical data are needed to clarify the critical features and to evaluate the emergency therapy for H1N1 influenza A in critically ill children.