甲型H1N1流感危重患儿5例临床分析.docVIP

甲型H1N1流感危重患儿5例临床分析 【摘要】 目的 探讨甲型H1N1流感危重症患儿的临床特点及诊疗体会。方法 回顾性分析5例儿童甲型H1N1流感危重症的临床表现、实验室检查及影像学资料、 治疗 及转归。结果 5例患儿均有发热等流感样症状，肺部受累严重，伴有明显气促、低氧血症、呼吸衰竭，部分病人出现心血管系统和中枢神经系统症状以及多脏器功能不全。实验室检查：白细胞计数正常、下降或升高。X线胸片提示肺部受累，片状阴影，进展迅速。达菲治疗效果较好，注意合并细菌感染可能性，同时应用抗生素;短期内应用大剂量静脉丙球、糖皮质激素冲击治疗可能是有效的。结论 甲型H1N1流感危重症患儿病情凶险，迅速恶化，死亡率高，早发现、早诊断、早治疗是降低死亡率的关键。 【关键词】 甲型H1N1流感;危重患儿;临床分析 　　[Abstract] Objective To investigate the Influenza A H1N1 influenza in children with critically ill patients in the clinical features and treatment experience.Methods Retrospective analysis of five cases of A H1N1 influenza critically ill children, clinical manifestations, laboratory examination and imaging data, treatment and prognosis were done.Results Five cases of children with fever and other flu-like symptoms, severe lung involvement, accompanied by marked shortness of breath, hypoxemia, respiratory failure, some patients had symptoms of cardiovascular system and central nervous system and multi-organ dysfunction. Laboratory examination: white blood cell was normal, decreased or increased. Prompt X-ray lung involvement, flake the shadow of rapid progress. Tamiflu treatment was better, pay attention to the possibility of bacterial infection, while application of antibiotics; short-term application of high-dose IVIG, the impact of glucocorticoid treatment may be effective.Conclusions A H1N1 influenza illness in children had the risks of rapid deterioration, high mortality, early detection, early diagnosis and early treatment is the key to reduce mortality. 　　[Key words] A H1N1 influenza;critical children;clinical analysis 　　2009年3月以来，始发于北美的甲型H1N1流感已引起全球大流行，危重症病例日益增多，特别是小儿病人，病情进展迅速，死亡率高[1]。我科在2009年12月11日—2010年1月21日期间收治了儿童危重症甲型H1N1流感5 例。现将患儿的临床表现、影像学资料、治疗及转归等进行分析 总结 ，现报告如下。 　 　1 资料与方法 　　1.1 一般资料 5例患儿中，男3例，女2例;年龄1岁10个月～4岁。5例危重症病人均无基础疾病。其中3例患儿临床表现为单纯的Ⅰ型呼吸衰竭，1例多脏器功能不全(中毒性脑病伴心功能不全)，1例合并一侧脓胸，肺脓肿。有2例病人发病前有H1N1流感患者接触史，所有病人均未进行流感疫苗接种。 　　1.2 诊断标准 按卫生部《甲型H1N1 流感诊疗方案》(第3版)。出现以下情况之一者为危重病例：(1)呼吸衰竭;(2)感染中毒性休克;(3)多脏器功能不全;(4)出