儿童重型和危重型流行性感冒临床特征及预后危险因素分析  

Analysis of Clinical Characteristics and Risk Factors of Severe and Critical Influenza in Children

作　　者：刘淑繁 戴漆 熊鹏[1] 黄浩[1] 张文迪[1] 袁义[1] 刘铜林[1] 陈瑜[1] Liu Shufan;Dai Qi;Xiong Peng(Department of Pediatric Intensive Care Unit,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Children's Respiratory Department,Maternal and Child Health Hospital of Hubei Province,Wuhan 430070,China)

机构地区：[1]华中科技大学同济医学院附属同济医院儿童重症医学科,武汉430030 [2]湖北省妇幼保健院儿童呼吸科,武汉430070

出　　处：《华中科技大学学报(医学版)》2025年第2期228-233,共6页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：湖北省财政厅公共卫生服务能力提升项目(No.SCZ2024013);湖北省卫健委科研项目(No.WJ2023M005)。

摘　　要：目的探讨儿童重型和危重型流行性感冒的临床特征,分析导致患儿预后不良的危险因素。方法采用回顾性研究对2020年1月至2023年12月于华中科技大学同济医学院附属同济医院儿童重症监护病房住院治疗的重型和危重型流感患儿的临床资料进行统计学分析。结果121名患儿中,重型流感患儿86例,危重型流感患儿35例。预后良好组患儿102例,预后不良组患儿19例。93名(76.9%)感染甲型流感,27名(22.3%)感染乙型流感,1名(0.8%)同时感染甲型、乙型流感。5岁以下患儿共67例(55.4%),临床表现以发热、咳嗽和惊厥为主。75例(62.0%)患儿合并肺炎,65例(53.7%)患儿诊断为流感相关性脑病,22例(18.2%)患儿进展为多器官功能障碍综合征。55例(45.5%)患儿合并其它病原体感染,21例(17.4%)合并细菌感染。危重型流感患儿合并细菌感染的发生率(31.4%)高于重型流感患儿(11.6%)(P<0.05)。合并细菌感染、出现神经系统症状及PCT指标升高是导致患儿预后不良的独立危险因素(均P<0.05)。结论5岁以下儿童易进展为重型和危重型流感病例,合并细菌感染增加不良预后风险发生的可能。预后不良的重型和危重型流感患儿常伴有神经系统表现,易遗留神经系统后遗症。Objective To investigate the clinical characteristics of severe and critical influenza children and analyze the risk factors affecting the prognosis of children.Methods Clinical data from children diagnosed with severe and critical influenza who were hospitalized in the pediatric intensive care unit of Tongji hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2020 to December 2023 were retrospectively collected and analyzed.Results Among the 121 children,86 cases had severe influenza and 35 cases had critical influenza.There were 102 children in the good prognosis group and 19 children in the poor prognosis group.In all,93 cases(76.9%)were infected with influenza A,27 cases(22.3%)were infected with influenza B,and 1 case(0.8%)was infected with both influenza A and B.Sixty-seven cases(55.4%)were under 5 years old.The main clinical manifestations were fever,cough and convulsions.Seventy-five cases(62.0%)were complicated with pneumonia,65 cases(53.7%)were diagnosed with influenza-associated encephalopathy,and 22 cases(18.2%)developed multiple organ dysfunction syndrome.Fifty-five cases(45.5%)were infected with other pathogens,21 cases(17.4%)had bacterial infection.The incidence of bacterial infection in children with critical influenza(31.4%)was higher than that in children with severe influenza(11.6%)(P<0.05).Bacterial infection,neurological symptoms and elevated PCT were independent risk factors for poor prognosis(P<0.05).Conclusion Children under 5 years old are more likely to develop severe and critical influenza.Bacterial co-infection increases the risk of poor prognosis.Poor-prognostic severe or critical influenza is often accompanied by neurological manifestations and residual neurological sequelae.

关 键 词：流行性感冒 重型 危重型 临床特征 危险因素 

分 类 号：R725.1[医药卫生—儿科]