40例呼吸道合胞病毒性肺炎患儿的临床症状及疗效观察

Clinical symptoms and observation on the therapeutic effects of 40 cases of respiratory syncytial virus pneumonia in sick children

目的通过分析40例呼吸道合胞病毒性肺炎患儿的临床症状及疗效,提高诊疗水平。方法选取40例呼吸道合胞病毒性肺炎确诊患儿,男22例,女18例,中位年龄为3个月。所有患儿入院后即进行血常规、肝肾功能、心肌酶谱、电解质、痰培养、痰病毒分离等检查,出院后随访1周;使用直接免疫荧光法检测呼吸道合胞病毒;40例患儿均行胸部X线摄片或CT检查确诊。治疗应用抗病毒、止咳氧喷对症处理,症状严重者使用激素和丙种球蛋白治疗。结果所有患儿均有下呼吸道感染表现。40例患儿外周血白细胞计数正常27例;C反应蛋白正常者31例;血小板增高16例;血清酶学的变化主要为丙氨酸转氨酶、天冬氨酸转氨酶、DBIL、乳酸脱氢酶、肌酸激酶同功酶的增高;病原学检查中,除呼吸道合胞病毒阳性外,合并其他病毒细菌感染共7例。31例胸片表现为支气管肺炎或支肺炎伴肺气肿。并发症包括电解质紊乱、肝功能损害、心肌损害、心力衰竭等。转归中显效34例(85.0%),有效6例(15.0%),平均住院天数(7.85±3.69)d。结论呼吸合胞病毒性肺炎具有发病年龄小、喘憋多见、程度中等,并发症以肝功能损害和电解质紊乱多见等特点,抗病毒、丙种球蛋白、喷雾等综合治疗疗效满意。

Objective To improve diagnosis and treatment through analyzing clinical symptoms of 40 cases of respiratory syncytial virus （RSV） pneumonia in sick children. Methods Our study selected 40 cases of confirmed respiratory syncytial virus pneumonia in sick children, among whom 22 were male and 18 were female, with an average age of 3 months. All sick children received associated medical examinations, such as blood routine, hepatorcnal function test, myocardial enzymes test, serum electrolyte test, sputum culture test and sputum virus test, after they were admitted into hospital. Follow-up visits were made, 1 week after discharge from hospital. Direct immunofluorescence was applied to detect respiratory syncytial virus and all the sick children had X-ray or CT for confirmation of the disease. Expectant treatment was made with anti-virus drugs and nebulization, in serious cases hormone and IVIgG were used in the treatment. Results All the sick children manifested infection of the lower respiratory tract. Twenty-seven cases out of 40 were normal in peripheral white blood cell counts. Thirty-one cases were normal in C-reaction protein and 16 cases showed that blood platelets increased to some extent. Changes in serum enzymes were chiefly manifested in the increased levels of alanine aminotransferase （ALT） , asparatate amin0transferase, （AST） , DBIL, lactate dehydrogenase （LDH） , and CKMB. Pathogenic examination showed that there were 7 cases of positive respiratory syncytial virus combined with other virus and bacterial infection. Chest X-ray showed 31 cases had bronchial pneumonia or bronehopneumonia with pulmonary emphysema. Complications included electrolyte disturbance, hepatic damage, myocardial damage and heart failure. Prognosis showed that there were 34 significant effectual cases （85.0%） and 6 effectual cases （ 15：： 0% ）. Average length of stay at hospital was 7.85± 3.69 days. Conclusion Respiratory syncytial virus pneumonia had such features as early morbidity among young children, moderate asthma, coupled with complications of hepatic damage and electrolyte disturbance. Comprehensive treatment with anti-virus drugs, IVIgG and nebulization could a- chieve satisfactory therapeutic effects.