甲型H1N1流感危重症患儿的临床特征与救治策略

Treatment strategy and clinical features of critically ill children with influenza A H1N1

目的总结甲型H1N1流感诊疗危重病例临床特点与救治策略。方法回顾性总结15例患儿甲型H1N1流感危重症病例的临床特点和救治策略,采用RT-PCR方法检测甲型H1N1流感病毒核酸(咽拭子标本)。结果基础疾病或高危因素仅占20.0%,所有患儿均有咳嗽和发热;奥司他韦抗病毒治疗,危重病例剂量加倍,疗程为5～10 d;80.0%患儿3 d内体温恢复正常,20.0%患儿5 d内体温恢复正常,全部病例临床治愈。结论儿童甲型H1Nl流感危重病例,应用奥司他韦抗病毒安全有效,对危重病例或合并胸膜炎者可考虑短期小剂量糖皮质激素,常规应用新鲜冰冻血浆等。

OBJECTIVE To summarize the clinical features and experience by treatment of severe Influenza A H1N1. METHODS The treatments for 15 children with influenza A H1N1 who were critically ill were reviewed and summarized. The clinical characteristics and treatment strategy were summarized, Influenza A H1N1 virus nucleic acid （throat swab specimens） were detect by RT-PCR. RESULTS The underlying diseases or risk factors accounted for 20.0%. All the sick children have a cough and fever. 20.0% cases of critically ill patients were 5 years of age. Oseltamivir was used to anti-viral therapy, critical illness dose is double for 5-10 days. 80.0% cases of body temperature returned to normal within 3 days; 20.0% cases of body temperature returned to normal within 5 days. All patients were clinically cured. CONCLUSION Regardless of long duration or fever, the application of oseltamivir is safe and effective in children with severe influenza A （H1N1）/critical illness. Severe cases or merger of pleurisy may consider short-term low-dose glucocorticoid and conventional fresh frozen plasma.