八例儿童重症甲型H1N1流感病例临床分析

Clinical analysis of eight pediatric severe influenza A （ H1N1 ） cases

目的分析儿童重症甲型H1N1流感病例的临床特征。方法总结8例重症甲型H1N1流感病例的临床表现和诊治经过。结果8例患儿均否认传染病接触史。4例有基础疾病，分别为肾病综合征、先天性甲状腺功能低下症、支气管哮喘及贫血。8例均有咳嗽和发热，咳嗽有痰，高热为主（5例），均有气促，出现在病程0．5—6d，且进行性加重，3—24h后出现呼吸衰竭；X线胸片为局限性渗出病变，类似支原体肺炎表现；血常规示7例中性粒细胞比例升高，6例CRP明显升高；均伴有呼吸衰竭，2例并发中毒性脑病。8例患儿均予抗病毒药物和脏器支持治疗，均使用了丙种球蛋白，部分患儿使用了皮质激素治疗，6例需要呼吸机支持，机械通气时间3—6d，无一例死亡。结论儿童重症甲型H1N1流感多是以严重低氧血症为突出表现的重症肺炎，经过及时有效的干预可避免严重急性呼吸窘迫综合征的发生，降低病死率。

Objective To analyze the clinical feature of pediatric severe influenza A （H1 N1 ） cases. Methods To summarize the clinical manifestation, diagnostic and therapeutic process of eight pediatric severe influenza A （H1 N1 ） cases. Results All eight cases couldn＇ t provide contact history. Four cases had fundamental diseases, which were nephrotic syndrome, congenital hypothyroidism, bronchial asthma and moderate anemia. All cases had cough and fever, which was productive cough and hyperpyrexia （5 cases）. All ca ses had tachypnea, which presented at the course of 0.5 - 6 days and progressively aggravated to respiratory failure 3 - 24 hours later. Chest x-ray showed localized exudation, which was similar to mycoplasma pneumonia. Seven cases had increased percentages of neutrophil. Six cases had increased CRP. All cases had respiratory failure;two cases were complicated with toxic encephacopathy. Treatment included anti-virus and support therapy. All cases received immunoglobulin and some cases received glucocorticoid. Six patients received mechanical ventilation. Time of mechanical ventilation was 3 - 6 days. No patients died. Conclusion Pediatric severe influenza A （H1N1） case is severe pneumonia with characteristic of severe hypoxemia. Acute respiratory distress syndrome and death can be prevented through effective and in-time therapy.