中国大陆地区住院儿童重症及危重症甲型H1N1流感临床过程分析  

Clinical features among severe and critical children admitted to hospital with 2009 pandemic influenza A(H1N1) in China's Mainland

作　　者：李晓莉[1] 曹彬[1] 梁立荣[1] 谷丽[1] 杨仕贵[2] 胡克[3] 章洪院[4] 阎锡新[5] 陈巍[6] 王辰[7,8] 

机构地区：[1]首都医科大学附属北京朝阳医院北京呼吸疾病研究所,100020 [2]浙江大学医学院附属第一医院传染病诊治国家重点实验室 [3]武汉大学人民医院呼吸科 [4]安徽大学附属第一医院呼吸科 [5]河北医科大学附属第二医院呼吸科 [6]中国医科大学附属盛京医院呼吸科 [7]北京呼吸疾病研究所 [8]卫生部北京医院

出　　处：《中华临床医师杂志（电子版）》2012年第10期100-105,共6页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨中国大陆地区2009年住院儿童重症以及危重症甲型H1N1流感临床过程以及预后。方法采用统一CRF表,收集中国大陆地区2009年9月1日至2009年12月31日收治的1137例住院儿童(年龄小于14岁)重症和危重症甲型H1N1流感患者的临床资料。确诊病例的定义为甲型H1N1流感病毒核酸检测阳性(实时荧光定量PCR方法)。结果中位年龄为4岁,22.6%的患儿年龄小于2岁。65.7%为男性。最常见的基础疾病为呼吸系统疾病(17.1%),主要症状为发热(1103例,97.3%)和咳嗽(1087例,95.7%)。86.3%患儿合并肺炎。1053例(92.6%)患儿接受奥司他韦抗病毒治疗,484例接受糖皮质激素治疗,263例需要机械通气。426例患儿入住ICU。所有入选患者中,58例死亡,难以纠正的低氧血症为死亡的主要原因。多因素回归分析显示年龄小于2岁(OR3.65,95%CI1.72～7.74)、免疫抑制状态(OR6.09,95%CI2.04～18.15)、呼吸困难(OR2.61,95%CI1.44～4.69)、咯血(OR3.65,95%CI1.38～9.65)以及神经系统症状(OR1.58,95%CI1.58～5.84)为死亡的独立危险因素。结论临床医师对于儿童甲型H1N1流感患者应高度重视,尤其是合并有免疫抑制状态的患者以及年龄小于2岁的儿童。难以纠正的低氧血症为死亡的主要原因。Objective To analyze course of disease and outcome of severe or critical eases among children admitted to hospital with 2009 pandemic H1N1 （pill N1 ） infections in China. Methods Using medical charts, we collected data on 1137 children who were hospitalized for at least 24 hours from Sep 1 st ,2009 to Dec 3 lst,2009, and who tested positive for the 2009 H1N1 virus with the use of a real-time reveme-transcriptase- polymerase-chain- reaction（rRT-PCR） assay. Results Median age of the 1137 children was 4 years,22. 6% were less than 2 years of age. 65.7% were male. The main co-mobidities were respiratory disease （ 17.1% ）. The most common symptoms were fever （ 1103 ; 97. 3% ） and cough （ 1087 ; 95.7% ）. 976 children （ 86. 3% ） had pneumonia. 1053 children （92. 6% ） received osehamivir treatment, corticosteroid therapy was administered to 484 patients and 263 received mechanical ventilation. 426 were treated in intensive care unit （ICU）. 58 of 1137 children died. The main cause of death was refractory hypoxemia （ 37 patients, 63. 8% ）. Age less than 2 years [ odds ratio （OR） 3.65,95% confidence interval （CI） 1.72-7.74 ], immunosuppressant （ OR 6. 79,95% CI 2. 40-19. 23 ）, dyspnea （ OR 2. 61, 95% CI 1.44-4. 69）, hemoptysis （ OR 3.65,95% CI 1.38-9. 65 ） and CNS symptom （ OR 1.58,95% CI 1.58- 5.84） were independent risk factors associated with death. Conclusions Clinicians should maintain high suspicion for infection in pediatric patients, particularly in children ≤ 2 years and those with immunosuppression. Severe hypoxemia is the main cause of death.

关 键 词：流感病毒A型 H1N1亚型 儿童 危险因素 

分 类 号：R725.1[医药卫生—儿科]