甲型H1N1流感重症和危重症患儿22例临床分析  

Analysis of 22 cases of children with severe and critical influenza A(H1N1)

作　　者：林小娟[1] 张志功[2] 

机构地区：[1]湖南省人民医院儿科医学中心,湖南长沙410000 [2]湖南省人民医院心胸外科,湖南长沙410000

出　　处：《临床和实验医学杂志》2011年第13期983-985,共3页Journal of Clinical and Experimental Medicine

摘　　要：目的分析甲型H1N1流感儿童重症和危重病例的临床特点,并对其诊治方法进行探讨。方法对2009年11月1日至2010年2月1日湖南省人民医院附属儿科医学中心收治的22例甲型H1N1流感重症和危重患儿的临床症状、实验室检查及影像学资料进行回顾性分析。结果所有患儿均有发热及咳嗽症状,伴气喘7例,气促呼吸困难7例,腹泻5例,恶心呕吐7例,抽搐,肢体抖动,双眼凝视2例,精神差6例,皮肤黏膜出血1例。实验室检查白细胞正常或下降为主,有神经系统并发症的患儿腰穿脑脊液常规生化检查无异常发现。入院肺部CT影像学表现主要为渗出性改变。经奥司他韦抗病毒,使用丙种球蛋白,激素抗炎,呼吸机支持通气等治疗,2例患儿死亡,其余患儿预后良好。结论新型甲型H1N1流感在儿童以肺部损伤为主,大多数预后较好,少数患儿因有原发基础疾病或病情进展迅速,伴发多器官功能衰竭。因此,对危重患儿应采取以抗病毒为主的综合支持治疗以降低病死率。Objective To analyze the clinical features of severe and critical children cases of influenza A（H1N1）and discuss its diagnosis and treatment.Methods Clinical manifestations,laboratory tests and imaging data of 22 children cases of severe and critical influenza A（H1N1） were retrospective analyzed.The cases reviewed were treated in Hunan Provincial People＇s Hospital affiliated Pediatric Medical Center from November 1,2009 to February 1,2010.Results Fever and cough occurred in all patients,other symptoms included asthma（7 cases）,shortness of breath and dyspnea（7 cases）,nausea and vomiting（7 cases）,mentally apathetic（6 cases）,diarrhea（5 cases）,seizures,limb jitter,and eye staring（2 cases）,and skin and mucous membrane bleeding（1 case）.Normal or decreased white blood cell count was found in laboratory test.Conventional and biochemical tests of cerebrospinal fluid in patient with neurological complications were negative.CT imaging findings on admission were mainly of pulmonary exudative changes.After antiviral treatment with oseltamivir,the use of gamma globulin,steroid anti-inflammatory,and support ventilation,2 patients（9%） died,the prognosis of other patients were good.Conclusion Influenza A（H1N1） can lead severe complications in children,mainly in the lungs.Most patients have good prognosis,a small number of patients due to the primary underlying disease or the rapid progress may associate with multiple organ failure.Therefore,critically ill children should be treated on the anti-viral-based integrated therapy to reduce mortality.

关 键 词：儿童 甲型H1N1流感 急症与重症 奥司他韦 

分 类 号：R720.597[医药卫生—急诊医学]