CAJ | 학술논문

目的了解儿童甲型H1N1流行性感冒(流感)病毒相关性肺炎的临床流行特征.方法通过描述性研究对2009年上海复旦大学附属儿科医院收治的30例甲型H1N1流感病毒所致肺炎的患儿做临床及流行病学分析.中位数比较采用秩和检验,率的比较采用精确卡方检验.结果 30例确诊为甲型H1N1流感合并肺炎的患儿中,年龄中位数为5.9岁,5例有基础疾病史,占16.7%.有明确发热病例暴露史的20例,占66.7%.所有患儿均有发热和咳嗽,11例伴气促,占36.7%,10例伴喘息,占33.3%.11例患儿WBC＜4.0×109/L,占36.7%,2例PLT减少,占6.7%.所有患儿入院时胸部X线片提示肺部有单侧或双侧片状渗出性病灶,4例危重症患儿肺部多处大片状渗出伴肺水肿,占13.3%,1例危重症肺炎患儿发病后3个月和9个月复查胸部CT提示不同程度肺纤维化,占3.3%,3例同时伴纵隔积气和皮下积气,占10.0%,6例并发急性呼吸衰竭,占20.0%,3例伴支气管哮喘急性发作,占10.0%,1例合并脑炎,占3.3%.所有患儿均给予奥司他书和抗菌药物治疗,4例接受机械通气,均治愈或好转出院.发病2 d内和2 d后接受奥司他韦治疗的患儿的热程中位数比较差异有统计学意义(2 d比5 d,Z=-8.015,P＜0.01).结论学龄前和学龄儿童易感染甲型H1N1流感病毒,可并发严重的肺部疾病.在发病早期采用奥司他韦治疗,可缩短热程,降低危重并发症的发生.
목적 료해인동갑형H1N1류행성감모(류감)병독상관성폐염적림상류행특정.방법 통과묘술성연구대2009년상해복단대학부속인과의원수치적30례갑형H1N1류감병독소치폐염적환인주림상급류행병학분석.중위수비교채용질화검험,솔적비교채용정학잡방검험.결과 30례학진위갑형H1N1류감합병폐염적환인중,년령중위수위5.9세,5례유기출질병사,점16.7%.유명학발열병례폭로사적20례,점66.7%.소유환인균유발열화해수,11례반기촉,점36.7%,10례반천식,점33.3%.11례환인WBC＜4.0×109/L,점36.7%,2례PLT감소,점6.7%.소유환인입원시흉부X선편제시폐부유단측혹쌍측편상삼출성병조,4례위중증환인폐부다처대편상삼출반폐수종,점13.3%,1례위중증폐염환인발병후3개월화9개월복사흉부CT제시불동정도폐섬유화,점3.3%,3례동시반종격적기화피하적기,점10.0%,6례병발급성호흡쇠갈,점20.0%,3례반지기관효천급성발작,점10.0%,1례합병뇌염,점3.3%.소유환인균급여오사타서화항균약물치료,4례접수궤계통기,균치유혹호전출원.발병2 d내화2 d후접수오사타위치료적환인적열정중위수비교차이유통계학의의(2 d비5 d,Z=-8.015,P＜0.01).결론 학령전화학령인동역감염갑형H1N1류감병독,가병발엄중적폐부질병.재발병조기채용오사타위치료,가축단열정,강저위중병발증적발생.
Objective To understand the clinical characteristics of pediatric patients who developed H1N1 influenza A virus-associated pneumonia during the outbreak of H1N1 influenza A in Shanghai. MethodsA dcscriptivc study was done to analyze the clinical and epidemiologic characteristics of 30 hospitalized children who developed complicated pneumonia caused by H1N1 influenza A virus infection in 2009 in Shanghai. The comparison of medians was done using rank sum test and comparison of rates was done using exact chi-square test. Results Among thirty pediatric patients with H1N1 influenza A virus-associated pneumonia, the median age was 5.9 years old, five cases (16.7 %) had pre-existing medical conditions. Twenty cases (66.7 % ) had been exposed to the classmates or family membcrs with fever. All cases had fever and cough. Eleven cases (36.7 %00 ) had tachypnca and ten (33.3%) had wheeze. Eleven cases (36.7%) showed white blood cell (WBC)＜4.0 × 109/L and 2 (6. 7%) had thrombocytopenia. All patients had bilateral or unilatcral patchy infiltrates in the lung indicated by chest X-ray and four (13. 3%) had extensive infiltrates with the evidence of pulmonary edema. One (3. 3%) critically ill child with pneumonia, chest computed tomography scan revealed lung fibrosis 3 months and 9 months after illness onset. Three(10. 0%) cases had pneumomediastinum and subcutaneous emphysema. Six cases (20. 0%) were complicated with acute respiratory failure, three (10. 0%) with acute asthmatic attack and one (3. 3%) with encephalitis. All patients were treated with oseltamivir plus antibiotics and four required mechanical ventilation. All patients survived. The median duration of fever in group with oseltamivir given within 2 days of fever onset was statistically shorter than that in group with oseltamivir given 2 days after fever onset (2 days vs 5 days, Z= -8. 015, P<0. 01). Conclusions Both pre-school age and schoolage children may develop complicated severe respiratory diseases after H1N1 influenza A virus infection. Early initiation of oseltamivir may shorten the duration of fever and reduce the occurrence of severe complications.