湘西地区甲型H1N1流感危重患儿4例临床特点分析

Clinical analysis of 4 children with severe influenza A (H1N1) virus infection

目的探讨湘西自治州少数民族地区甲型H1N1流感危重患儿临床特点及诊疗体会。方法回顾性分析资料完整的本院儿科住院4例甲型H1N1流感危重患儿临床表现、实验室检查及影像学资料。结果 4例患儿早期无特异性表现,均为流感样症状。3例发热,1例病初体温未测,4例均咳嗽,少量痰液,病情加重可出现咳嗽加重,均有呼吸困难,无腹泻呕吐,2例3d未排大便,伴腹胀;随着病情进展都有多脏器功能不全,其中以肺脏受累最为突出。实验室检查:白细胞计数正常、降低或升高,多有肝肾功能异常。X线胸片提示双肺均有广泛受损害,表现为大片状高密度影。结论甲型H1N1流感危重患儿病情凶险,进展迅速,病死率高。因此,为了降低发病率,特别是降低危重症发病率,必须加强小于5岁的农村儿童甲型H1N1流感疫苗接种及防控工作,同时注重针对合并营养性缺铁性贫血儿童的早期治疗。早发现,早诊断,早期综合治疗,是降低甲型H1N1流感危重症病死率的关键。

Objective To discussthe clincal featuresand realizationof severe influenza A （ H1N1） virus infection for children in the nationnal minority in the west of Hunan province. Methods Analyzed the clin-ical features,laboratory examinations and imaging data of 4 children with severe influenza A （ H1N1） virus infection for children. Results 4 children with severe influenza A（ H1N1） virus infection did not have special symptoms and signs,just had flu-like symptoms. 3 had a fever,1 didn＇t measure temperature in the beginning of disease,4 all had cough with a little amount phlegm. When the patients＇conditions worsen,they had bad coughs,breathing difficulities,and no diarrhea or vomitting,2 didn＇t moke stool for 3 days with abdominal distension. The patients often experience MODS,among them the lungs were prominent. In laboratory examinations,white blood cells counts normal,low or high,most of them experience abnormal function of the liver and kidney. The x-ray manifest that many parts of the lungs were damaged,the part of wide area shadow of hight density. Conclusion Severe influenza A（ H1N1） virus infection in children develop at an alarming rate,the risk of death is high. Therefore,in order to reduce the incidence of the desease,especially the incidence of the severe symptoms,it is necessary that we have to enhance the work of the inoculation of vaccine influenza A （ H1N1） virus,precaution and control to the country children who are less than 5 years old. In the meantime,it is also important that we must take more attentions to the early treatment for children who have nourishment and iron-deficiency anemia. Early recognization,early diagnosis and early treatment is the key to reduce the death rate of severe influenza A （ H1N1） virus infection.