48例儿童甲型H1N1流感病例临床分析

Clinical analysis of 48 children with novel influenza A (H1N1) virus infection

目的探讨儿童甲型H1N1流感患者的临床特征和治疗特点。方法回顾分析广东省人民医院2009年9月19日～12月30日收治的48例住院儿童甲型H1N1流感病例的临床资料,总结其临床特征及治疗经验。结果 14例为轻症患儿,30例为重症患儿,4例为危重症患儿。48例确诊病例均为本地发病者,其中10例有明确的甲型H1N1流感患者接触史。表现为发热(100%),咳嗽(93.8%),气促(35.4%),喘息(25%),呼吸困难(4.16%),腹泻(12.5%);50%患儿合并肺炎,2例并发心肌炎,5例患儿合并胸腔积液,其中2例出现呼吸衰竭;75%患儿白细胞正常或减低,45.8%患儿有肌酸激酶(CK)增高。按照卫生部《甲型H1N1流感诊疗方案(2009年第三版)》给予奥司他韦抗病毒、预防感染、吸氧、营养心肌及对症支持治疗,积极治疗基础疾病,必要时给予呼吸机支持、胸腔穿刺引流,所有患儿均痊愈。结论甲型H1N1流感患儿临床表现以呼吸系统症状为主,肺炎是常见并发症,少数患儿合并胸腔积液,甚至出现呼吸衰竭;接近半数患儿伴有不同程度心肌酶损害,少数并发心肌炎;尚未发现神经系统并发症;奥司他韦治疗敏感,采取综合治疗预后良好。

Objective To analysis the clinical features of children with novel influenza A（H1N1） virus infection and treatment of the disease.Methods Clinical data from 48 patients admitted to our hospital during 19 September to 30 December 2009 were studied retrospectively.Results Totally 14 mild cases,30 severe cases and 4 critically ill cases were treated.All the 48 children with the novel influenza A（H1N1） virus infection were domestic cases.10 cases contacted closely with influenza A（H1N1） patients.Clinical symptoms of those patients were fever（100% ）,cough（93.8% ）,shortness of breath（35.4% ）,wheezing（25%）,respiratory distress（4.16%）,diarrhea（12.5%） .Half of the children have pneumonia.2 patients had complicated myocarditis.5 patients had hydrothorax and two of them developed respiratory failure.The white blood cells in 75% children were normal or reduced.45.8% of children had creatine kinase（CK） increased.All the patients were treated according to the guidline of influenza A（H1N1） diagnosis and treatment（2009 Third Edition） issued by the Ministry of Health of China.General combination therapy included anti-viral oseltamivir,inspiring oxygen,myocardial protection,etc.Patients with underlying diseases need aggressive treatment.Some patients need mechanical ventilatory support,thoracic puncture and drainage.All the cases recovered completely.Conclusions Respiratory symptoms were the main clinical manifestations of the patients with influenza A（H1N1） infection.Pneumonia is the most common complication.A small number of children had pleural effusion and developed to respiratory failure.Nearly half of the children accompanied by varying degrees of myocardial enzyme damage and two cases had myocarditis.We did not yet discover the nervous system complications.Oseltamivir treatment was sensitive and early general combination therapy was effective.The prognosis is good.