重症甲型H1N1流感10例临床分析

A clinical analysis of 10 cases of severe influenza A H1N1

目的 探讨重症甲型H1N1流感的临床和治疗特点.方法 对2009年11月～12月中旬在西安交通大学医学院第一附属医院住院确诊为重症甲型H1N1流感患儿的临床表现、实验室检查结果 、治疗及预后等资料进行回顾性分析.结果 重症患儿中50%有基础病变,30%年龄小于5岁.所有患儿均有发热、咳嗽表现,合并有肺炎,70%有肺外并发症,4例有肝功损害,6例有心肌酶异常,2例出现肾功异常.所有患儿均予奥司他韦、抗生素对症治疗,呼吸衰竭、肝功损害、心肌损害、肾功不全者给予相应的呼吸机辅助通气、营养心肌、血液净化等治疗,多脏器功能障碍者及时用乌斯他汀.除1例由于原发病（急性白血病）过重死亡,余患儿均痊愈出院.结论 重症甲型H1N1流感患儿尽早、足量应用奥斯他韦、抑制炎症介质释放药物及支持对症等治疗,预后良好.

Objective To investigate clinical characteristics of severe influenza A H1N1 in children and explore treatment of the disease. Methods The clinical manifestations, laboratory results, treatment and outcome of children with severe influenza A H1 N1 who admitted to and were treated in our hospital in a period from November to mid of December, 2009 were analyzed retrospectively. Results 50% of the children with severe influenza A HI N1 had primary diseases, 30% of them aged less than 5 years. All of the children had fever and cough. Radiography shown that all of them had sign of pneumonia. 70% of them had extra-pulmonary complications. 4 children had hepatic dysfunction, 6 children had myocardial damage, 2 children had impairment of renal function. All of the children were given oseltamivir, antibiotics and symptomatic treatment. Those had respiratory failure, hepatic dysfunction, myocardial damage or impairment of renal function were given assisted mechanical respiratory by ventilator, myocardial trophotherapy, or blood purification respectively. Those children with muhiorgan dysfunction were given ulinastatin promptly. 1 child died of severe primary disease （acute leukemia） and rest 9 children cured. Conclusion Those children with severe influenza A H1 N1 should be given full dose of oseltamivir, inflammatory mediators inhabiting agents and symptomatic and supporting treatment as early as possible. The prognosis of the children is good.