重型β地贫并危重症甲型H1N1流感1例追踪观察

Follow-up observation of a case of β-thalassemia major with influenza A(H1N1) virus infection

目的追踪观察1例重型β地贫并危重症甲型H1N1流感患儿,探讨其诊治经验。方法通过对1例重型β地贫并免疫性溶血性贫血脾切除术后合并危重症甲型H1N1流感患儿的症状体征、住院病情演变经过及相关实验室检查,以及行呼吸衰竭抢救治疗等观察并记录,对以上资料进行综合分析。结果入院后经免疫抑制治疗未能控制免疫性溶血性贫血,行脾切除术,术后合并甲型H1N1流感,并出现呼吸衰竭,经呼吸机辅助通气,积极抗感染,糖皮质激素等综合治疗后,患儿遗留肺纤维化,但输血间隔时间明显延长。结论儿童重型β地中海贫血并免疫性溶血性贫血行脾切除术后并危重症甲型H1N1流感起病急、进展快,及时综合治疗预后好。

Objective To analyze the reslts of diagnosis and treatment of a case of β-thalassemia major combined with immune hemolytic anemia who was critical ill with influenza A（H1N1） virus infection post-splenectomy after further observation.Methods Clinical manifestations,evolution of the disease,laboratory and respiratory failure therapy data of the patient were analyzed.Results The immune hemolytic anemia could not be controlled after immunologic suppression.Splenectomy was performed in order to cure the disease,the patient was infected by influenza A（H1N1）virus developed to acute respiratory distress syndrome（ARDS）after 16 days of splenectomy.The patient was intubated and mechanically ventilated.Antibiotics and corticosteroids treatment were also received.He survived and sequenced with pulmonary fibrosis.Now the duration of RBC infusion is prolonged.Conclusion Splenectomy is effective with the patient ofβ-thalassemia major combined with immune hemolytic anemia.Critically ill children with influenza A（H1N1）virus infection developed severe manifestations.The prognosis will be improved after combined therapy immediately.