儿童甲型H1N1流感危重症中医药早期介入救治体会

Experience of Early Intervention in Children′ s Severe Pandemic Influenza A (H1N1) Treatment with Traditional Chinese Medicine

目的总结甲型H1N1流感危重症患儿的临床表现特点及救治经验,为判断病情和治疗提供参考,以期提高此类患儿的治愈率。方法对8例甲型H1N1流感危重症患儿的一般资料、临床主要症状、证候演变(其中包括临床症状、体征、实验室检查)、综合治疗措施及预后进行回顾性分析,总结其规律及治疗方法。结果甲型H1N1流感病毒可以侵犯全身多个器官,临床表现多样,感染儿童后进展较快,危重病例较多,死亡率高。本研究8例患儿入院后均采用中西医结合救治方案,辨证施治,及早给予中医药治疗,西医综合治疗给予保护性肺通气策略以及限制性液体复苏、血管活性药物、营养支持和器官保护治疗,早期给予奥司他韦抗病毒,联合抗生素抗感染,适量糖皮质激素抗炎、免疫调节等。危重患儿早期中医辨证以热毒闭肺及邪陷营血证多见,8例患儿均辅以清热解毒的中药鼻饲治疗。给予综合治疗后,5例治愈出院,3例因胸片未完全恢复好转出院,1个月后随访均恢复正常,无死亡病例。结论甲型H1N1流感危重症病例可以出现多系统功能障碍,临床应早期诊断、尽早干预治疗,及时给予中西医综合救治措施,可以提高疗效,有效降低死亡率。

Objective： To summarize the clinical features and treatment experience of severe cases of pandemic influenza A（H1N1 ） in order to provide the reference for judging condition and treatment,and to improve the cure rate of the children. Methods： The general information,the main symptoms and the symptom evolution which included the evolution of symptoms ,manifestations ,laboratory examinations ,treatment and prognosis of 8 severe cases of pandemic influenza A （H1N1） were retrospectively analyzed. Results： Influenza a （H1N1） viruses can invade multiple organ ,induce diverse clinical manifestations. Infected children deteriorated faster and occurred more severe, higher mortality. At the first onset, they were treated with western medicine treatment and early intervention treatment of traditional Chinese medicine which was based on syndrome differentiation. Western medicine comprehensive treatment were applied such as lung protective ventilation strategies ,limiting fluid resuscitation,vascular active pharmaceutical, nutritional support, organ protection treatment, early antiviral oseltamivir, antibiotic resistance to infeetion,a moderate amount of glueocortieoid anti-inflammatory and immune regulation. Most of the TCM syndromes of severe cases were the heat-toxin blocking the lung syndrome and exuberant toxin in both ying and xue syndrome.8 cases were fed through nasogastric tubes with heat-clearing and detoxicating prescription. Finally, 5 cases were cured and discharged after giving comprehensive treatment. 3 cases improved in hospital on account of their chest X-ray were not completely restore. There were no deaths in these children. All of them were back to normal after 1 month of follow-up visit. Conclusion： Severe cases of pandemic influenza A （H1N1） can develop more system dysfunction （MODS）. It can improve curative effect,reduce the mortality effectively by early diagnosis that early intervention and a timely manner for integrated traditional Chinese and western medicine treatment measures were given the children.