儿童重症和危重症2009甲型H1N1流感临床特征  

Characteristics of severely and critically ill children with 2009 influenza A （H1N1） virus infection

作　　者：卢志威[1] 邓继岿[1] 郑跃杰[1] 何颜霞[2] 杨卫国[2] 魏菊荣[1] 张交生[1] 李博宁[2] 李晓楠[1] 宋萍[2] 余珍珠[1] 赵辉[1] 王立[1] 马颐姣[2] 汤正珍[1] 刘晓莉[1] 李雨铮[1] 李成荣[2] 

机构地区：[1]遵义医学院深圳儿童医院呼吸科,518026 [2]遵义医学院深圳儿童医院重症医学科,518026

出　　处：《中华儿科杂志》2010年第8期571-574,共4页Chinese Journal of Pediatrics

摘　　要：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.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 laborato

关 键 词：流感 人 流感病毒A型 H1N1亚型 危重病 儿童 

分 类 号：R459.7[医药卫生—急诊医学]