CAJ | 학술논문

儿童重症和危重症2009甲型H1N1流感临床特征
인동중증화위중증2009갑형H1N1류감림상특정
Characteristics of severely and critically ill children with 2009 influenza A (H1N1) virus infection

万方数据

中华儿科杂志中華兒科雜誌 중화인과잡지
Chinese Journal of Pediatrics
2010年 8期 571-574 ,共4页

卢志威%邓继岿%郑跃杰%何颜霞%杨卫国%魏菊荣%张交生%李博宁%李晓楠%宋萍%余珍珠%赵辉%王立%马颐姣%汤正珍%刘晓莉%李雨铮%李成荣

로지위%산계규%정약걸%하안하%양위국%위국영%장교생%리박저%리효남%송평%여진주%조휘%왕립%마이교%탕정진%류효리%리우쟁%리성영

流感,人%流感病毒A型,H1N1亚型%危重病%儿童流感,人%流感病毒A型,H1N1亞型%危重病%兒童
류감,인%류감병독A형,H1N1아형%위중병%인동
Influenza,human%Influenza A virus,H1N1 subtype%Critical illness%Child

目的报道儿童2009甲型H1N1流感重症与危重症的临床特征.方法对150例经咽拭子实时荧光定量PCR检测确诊为2009甲型H1N1流感重症与危重症患儿的临床资料进行分析.结果 150例患儿中,男103例,女47例,年龄中位数为5岁;≥5岁81例,合并基础疾病21例.常见的表现依次为发热142例(95%),咳嗽133例(89%),呕吐35例(23%),喘息29例(19%),腹痛24例(16%),嗜睡11例(7%),惊厥9例(6%),肌痛9例(6%)和腹泻9例(6%).常见的检验异常为外周血白细胞计数异常60例(40%),C反应蛋白增高49例(33%),乳酸脱氢酶增高4.4例(29%),肌酸激酶增高38例(25%)和天冬氨酸转氨酶增高29例(19%).并发症主要为肺炎97例(65%),脑病18例(12%)和心肌炎7例(5%).使用奥司他韦治疗109例(73%),使用糖皮质激素治疗35例(23%).32例(21%)入住ICU,13例接受气管插管机械通气,14例接受支气管镜检查及冲洗.145例(97%)患儿治愈出院,5例死亡,其中3例死于脑病,1例死于急性呼吸窘迫综合征,1例死于继发性真菌性脑膜炎.结论重症和危重症2009甲型H1N1流感主要发生在没有基础疾病的年长儿,其表现及检验异常比较广泛.神经系统并发症发生率较高,严重的脑病可引起死亡.早期行支气管镜检查及冲洗有可能减少肺部并发症引起的死亡.
목적 보도인동2009갑형H1N1류감중증여위중증적림상특정.방법 대150례경인식자실시형광정량PCR검측학진위2009갑형H1N1류감중증여위중증환인적림상자료진행분석.결과 150례환인중,남103례,녀47례,년령중위수위5세;≥5세81례,합병기출질병21례.상견적표현의차위발열142례(95%),해수133례(89%),구토35례(23%),천식29례(19%),복통24례(16%),기수11례(7%),량궐9례(6%),기통9례(6%)화복사9례(6%).상견적검험이상위외주혈백세포계수이상60례(40%),C반응단백증고49례(33%),유산탈경매증고4.4례(29%),기산격매증고38례(25%)화천동안산전안매증고29례(19%).병발증주요위폐염97례(65%),뇌병18례(12%)화심기염7례(5%).사용오사타위치료109례(73%),사용당피질격소치료35례(23%).32례(21%)입주ICU,13례접수기관삽관궤계통기,14례접수지기관경검사급충세.145례(97%)환인치유출원,5례사망,기중3례사우뇌병,1례사우급성호흡군박종합정,1례사우계발성진균성뇌막염.결론 중증화위중증2009갑형H1N1류감주요발생재몰유기출질병적년장인,기표현급검험이상비교엄범.신경계통병발증발생솔교고,엄중적뇌병가인기사망.조기행지기관경검사급충세유가능감소폐부병발증인기적사망.
Objective To analyze the clinical characteristics of severely and critically ill children with 2009 influenza A (H1N1) infection. Method Clinical data of 150 cases with 2009 influenza A (H1N1) virus infection confirmed with the use of a real-time polymerase-chain-reaction assay on nasopharyngeal swab specimens were analyzed. Result Among 150 severely and critically ill children with 2009 influenza A (H1N1) virus infection, 103 were male, 47 were female; the median age was 5 years, 81 (55% ) were 5 years of age or older; 21 (14% ) had underlying chronic diseases. The most common presenting symptoms were fever (95% ) , cough (89% ) , vomiting (23% ) , wheezing (19% ) , abdominal pain (16% ) , lethargy (7% ) , seizures (6% ), myalgia (6% ), and diarrhea (6% ) . The common laboratory abnormalities were increased or decreased white blood cells counts (40% ), elevated of CRP (33%), LDH (29%), CK (25%) and AST (19%). Clinical complications included pneumonia (65% ) , encephalopathy (12% ), myocarditis (5% ) , encephalitis(1% ) and myositis (1% ). All patients had received antibiotics before admission or on admission; 73% of patients had received oseltamivir treatment, 23% of patients had received corticosteroids; 32(21% ) were admitted to an ICU, 13 patients were intubated and mechanically ventilated. Fourteen patients with dyspnea who were irresponsive to the treatment experienced bronchoalveolar lavage with flexible bronchoscopy, and the branching bronchial casts were removed in 5 patients. Totally 145 (97% ) patients were discharged, five (3% ) died, three previously healthy patients died from severe encephalopathy, one patient died from ARDS, one previously healthy patient died from secondary fungal meningitis. Conclusion Severely and critically ill children with 2009 influenza A (H1N1) virus infection may occur mainly in older children without underlying chronic disease. The clinical spectrum and laboratory abnormality of the patients can have a wide range. Neurologic complications may be common and severe encephalopathy can lead to death in previously healthy children. Early use of bronchoalveolar lavage with flexible bronchoscopy may reduce death associated with pulmonary complications.