先天性心脏病患儿术后呼吸道合胞病毒感染的临床分析

Clinical analysis of postoperative respiratory syncytial virus infection in children with congenital heart disease

目的探讨先天性心脏病患儿术后呼吸道合胞病毒感染的临床特征及其耐药性,为临床诊治提供参考。方法选取医院心胸外科收治的先天性心脏病手术患儿803例,以术后出现呼吸道合胞病毒感染的25例为观察组,另选同期术后未出现呼吸道合胞病毒的25例患儿作为对照组,对两组患儿治疗情况以及临床表现进行统计,以蚀斑试验结合原位杂交法对合胞病毒的耐药性进行监测,采用SPSS13.0软件进行统计分析。结果观察组72.00%患儿行RACHS-2级手术,使用高频振荡通气率以及病死率分别为36.00%和20.00%,对照组分别为52.00%、4.00%、0;观察组患儿呼吸机辅助时间和ICU住院时间明显长于对照组,两组差异有统计学意义(P<0.05);观察组患儿均在发病前有上呼吸道感染接触史及咳嗽症状,96.00%有鼻塞、流涕等上感症状,此外分别有56.00%、52.00%、52.00%患儿出现肺部湿啰音和痰鸣音、口吐白沫以及嗜睡症状;实验室检查56.00%患儿白细胞计数<10×109/L,76.71%中性粒细胞<0.5;影像学检查80.00%患儿表现为小点状、斑片状阴影;呼吸道合胞病毒对更昔洛韦、利巴韦林、膦甲酸钠耐药率分别为20.00%、32.00%、44.00%。结论小儿先天性心脏病术后呼吸道合胞病毒感染临床表现多样,RACHS-2级手术、使用高频振荡通气、长时间呼吸机辅助治疗以及长时间住ICU是其高危因素,一旦发生感染,患儿病死率可显著提高,应选择敏感抗病毒药物进行及时治疗。

OBJECTIVE To explore the clinical characteristics of postoperative respiratory syncytial virus infection in the children with congenital heart diseases and analyze the drug resistance so as to provide guidance for clinical diagnosis and treatment.METHODS A total of 803 children with congenital heart disease who underwent surgeries in our Cardio-Thoracic Surgery center were enrolled in the study,25 children with postoperative respiratory syncytial virus infection were assigned as the observation group,meanwhile,25 children without postoperative respiratory syncytial virus infection were set as the control group.The treatment situation and clinical manifestations were statistically analyzed,the surveillance of drug resistance of cytomegalovirus was carried out by means of plaque test combined with in situ hybridization method,and the statistical analysis was performed with the use of SPSS13.0software.RESULTS In the observation group,72.00% of the children underwent the RACHS-2surgery,with the utilization rate of high frequency oscillatory ventilation 36.00%,the mortality rate 20.00%.In the control group,52.00% of the children underwent the RACHS-2surgery,with the utilization rate of high frequency oscillatory ventilation 4.00%,the mortality rate 0.The mechanical ventilation duration and length of ICU stay of the observation group were significantly longer than those of the control group（P〈0.05）.In the observation group,all the children had the contact history of upper respiratory tract infections before the onset,96.00% had the flu symptoms nasal congestion and runny nose,56.00% had the lung wet rales,52.00% had the phlegm tone and foaming at the mouth,and 52.00% had the lethargy.The laboratory examination showed that 56.00% of the children were with the white blood cells counts less than 10×10^9/L,and 76.00% were with the neutrophils less than 0.5.The imaging examination indicated that 80.00% of the children manifested the small dot,patchy shadows.The drug resistance rates of the respiratory syncytial virus to ganciclovir,ribavirin,and foscarnet were20.00%,32.00%,and 44.00%,respectively.CONCLUSIONThe clinical manifestations of the children with congenital heart disease complicated with postoperative respiratory syncytial virus infection are diversified,and the high risk factors included the RACHS-2surgery,use of high frequency oscillatory ventilation,long mechanical ventilation duration,and long length of ICU stay.The mortality rate of the children is significantly increased once the infections occurs,and it is necessary to choose sensitive antiviral drugs for timely treatment.