9例重症登革热死亡病例分析

Analysis of nine death cases with severe dengue fever

目的分析重症登革热死亡病例的临床特征和死亡原因。方法回顾性分析2014年6月23日至2019年9月10日广东省9例重症登革热死亡患者的临床资料和死亡报告等。9例患者均经反转录聚合酶链反应确定血清登革病毒核酸阳性,部分患者进行病毒血清学分型。结果9例患者中位年龄为57.5岁,年龄范围为18~80岁;其中女6例;8例为本地病例,1例为输入性病例;发病集中于9月至10月。发病至就诊中位时间为3 d,发病至确诊中位时间为4 d。9例患者中,3例有基础疾病。9例患者均有发热,其中双峰热3例。入院前存在3项以上重症登革热预警指征者8例。入院时严重出血3例,休克1例,器官功能衰竭6例。3例患者进行了侵入性或有创性检查治疗,其中动脉穿刺置管、胃镜下钛夹止血、经皮穿刺插管冠状动脉造影术各1例。术后2例患者发生恶性心律失常,1例发生皮下软组织大量出血。死亡原因为暴发性心肌炎导致心源性休克和致死性心律失常4例,脑炎和脑病3例,难治性休克1例,急性肝衰竭1例。6例进行血清学分型的患者中,登革病毒型(dengue virus type,DEN)-1有4例,DEN-2有2例。结论重症登革热患者主要死因为严重器官衰竭,尤其是暴发性心肌炎,以DEN-1感染多见。早期识别、及时救治、尽量避免有创性操作等可有效降低重症登革热患者的病死率。

Objective To analyze the clinical features of death cases of dengue fever and the causes of their deaths.Methods The clinical data and death reports of nine death cases of dengue fever in Guangdong Province from June 23,2014 to September 10,2019 were retrospectively analyzed.All of nine cases were positive for serum dengue virus RNA as confirmed by reverse transcription polymerase chain reaction,and some of the virus strains were serotyped.Results The median age of the nine patients was 57.5(range:18-80)years.Among them,six patients were females;eight patients were local cases and one was imported case;all of nine cases occurred in September and October.The median time from onset to visit hospital and diagnosis was three and four days,respectively.Three of the nine patients had underlying diseases.All of nine cases had fever,including three with double-peak fever.Eight of the cases had three or more severe dengue fever warning indexes before admission.Three cases had severe bleeding upon admission,one case had shock,and six cases had organ failure.Three cases underwent invasive examination,including arterial puncture catheterization,endoscopic titanium clip hemostasis,and percutaneous transluminal coronary angiography.Two cases developed malignant arrhythmia and one had massive hemorrhage of subcutaneous soft tissue after operation.The death cases included four cases of cardiogenic shock and fatal arrhythmia,three cases of encephalitis and encephalopathy,one case of refractory shock,and one case of acute liver failure.Among the six cases that underwent serological typing,four were identified as dengue virus type 1(DEN-1)and two were DEN-2.Conclusions Severe organ failure is the major cause of dengue fever-related death,especially fulminant myocarditis,and DEN-1 is most common.Early diagnosis and treatment,and avoidance of invasive procedures can effectively reduce the mortality rate of the severe dengue fever patients.