百日咳致婴儿死亡的机制和预防

Mechanism and prevention of death caused by pertussis in infants

重症百日咳病死率近年下降不明显。肺动脉高压、持续性心动过速、早期重度呼吸衰竭、频发的神经症状、严重的高白细胞和淋巴细胞血症等提示恶性百日咳。直接死因为难治性休克和低氧血症，死亡甚至发生于病情好转出院之后。治疗上除抗感染、对症、生命支持等外，对伴有高白细胞血症引起的难以纠正的肺动脉高压、心源性休克者，可早期进行血液置换。百日咳流行地区的小婴儿可提前进行预防接种，高危易感者暴露后可及时使用大环内酯类抗生素预防发病或延缓病情进展。

The mortality of severe pertussis has not been significantly decreased in recent years. Persistent pul- monary hypertension, continuous tachycardia, severe respiratory failure in early stage and frequent severe nerve damage, severe hyperlipidemia and hypercholesterolemia, etc. suggest malignant pertussis. Refractory shock and hypoxemia are direct causes of death, and even died after discharge. In addition to anti - infection, symptomatic treatment and life svp- port, early blood replacement can be performed, when children are accompanied refractory pulmonary hypertension and cardiogenic shock caused by hyperlipidemia. Infants in high - risk areas can be vaccinated ahead of plan, and macrolide antibiotics can be used for the people in high risk to prevent onset or delay the progress of disease after exposed.