CAJ | 학술논문

目的探讨小儿甲型H1N1流感危重症患儿的发病特点及治疗措施.方法 2009年10月5日至11月15日期间我院PICU收治11例出现甲型H1N1流感样症状合并重症肺炎、急性呼吸窘迫综合征(ARDS)患儿,对其发病特点、治疗方法及转归等资料进行分析.结果 11例甲型H1N1流感样患儿合并重症肺炎、ARDS,其中6例经咽拭子检测甲型H1N1流感病毒核酸阳性.患儿平均年龄3.9岁(10个月～11岁).所有患儿都表现为发热和呼吸系统症状,从发病到出现危重症状的时间为5～10 d.6例行机械通气治疗.目前全部病例存活,无一例死亡.6例机械通气患儿已有4例安全脱机,2例仍在机械通气中.结论重症甲型H1N1流感患儿病初为流感症状,无特殊临床表现;病情可在短时间内迅速加重,重症患儿以呼吸困难、低氧血症为突出表现;婴幼儿可伴有嗜睡、烦躁等神经系统症状;重症患儿肺部病变广泛,进展迅速,可在短时间内出现纵隔及皮下气肿、ARDS甚或肺出血并随之出现多脏器功能障碍综合征.
목적 탐토소인갑형H1N1류감위중증환인적발병특점급치료조시.방법 2009년10월5일지11월15일기간아원PICU수치11례출현갑형H1N1류감양증상합병중증폐염、급성호흡군박종합정(ARDS)환인,대기발병특점、치료방법급전귀등자료진행분석.결과 11례갑형H1N1류감양환인합병중증폐염、ARDS,기중6례경인식자검측갑형H1N1류감병독핵산양성.환인평균년령3.9세(10개월～11세).소유환인도표현위발열화호흡계통증상,종발병도출현위중증상적시간위5～10 d.6례행궤계통기치료.목전전부병례존활,무일례사망.6례궤계통기환인이유4례안전탈궤,2례잉재궤계통기중.결론 중증갑형H1N1류감환인병초위류감증상,무특수림상표현;병정가재단시간내신속가중,중증환인이호흡곤난、저양혈증위돌출표현;영유인가반유기수、번조등신경계통증상;중증환인폐부병변엄범,진전신속,가재단시간내출현종격급피하기종、ARDS심혹폐출혈병수지출현다장기공능장애종합정.
Objective To describe baseline characteristics,treatment,and outcomes of consecutive critically ill children in PICU of Shengjing Hospital China Medical University that treated the majority of such patients with confirmed,probable,or suspected 2009 influenza A(H1N1). Methods Observational study of 11 critically ill children with 2009 influenza A(H1N1) between October 1 and November 18,2009. Symptoms, comorbid conditions, illness progression, treatments, and clinical outcomes were collected using a piloted case report form. Results The average age of 11 patients was 3.9 years (10 months～11 years). All presented with fever and respiratory symptoms. Time from the onset of the disease to PICU admission was 5～10 days,and 6 patients with severe acute respiratory distress syndrome and refractory hypoxemia. No patients died until now. Six patients who received mechanical ventilation had greater initial severity of illness,worse hypoxemia,higher creatine kinase levels,higher creatinine levels,and ongoing organ dysfunction. Conclusion Critical illness from 2009 influenza A (H1N1) occurred in children was associated with severe pneumonia,acute respiratory distress syndrome and ongoing organ dysfunction.