儿童下呼吸道流感病毒感染危重症临床特征分析

Analysis of the clinical characteristics of lower respiratory tract infection of influenza virus-related critical illness in children

目的对儿童下呼吸道流感病毒感染所致的危重症病例临床特征进行分析,旨在提高对流感危重症的认识,为临床早期识别及诊治提供参考依据。方法回顾分析2018年10月至2019年10月深圳市儿童医院收治入院的下呼吸道流感病毒感染危重症病例(危重症组)30例,并将其临床资料与下呼吸道流感病毒感染的普通重症病例(普通重症组,n=40)进行比较。结果危重症患儿以小于5岁多见(19例,63.33%),以男孩为主(25例,83.33%)。与普通重症组相比,危重症夏季发生比例明显升高(χ2=7.050,P=0.008),肺部湿啰音发生率明显升高(χ2=5.222,P=0.022),出现重症肺炎比例明显增加(χ2=32.651,P<0.001),危重并发症中呼吸衰竭多见(18例,60.00%),出现塑型性支气管炎比例显著升高(χ2=7.797,P=0.005)。危重症组患儿血常规以中性粒细胞增高为主,中性粒细胞绝对值高于普通重症组(Z=-3.805,P<0.001),CRP升高比例显著增加(χ2=5.833,P=0.016);灌洗液培养以肺炎链球菌为主(9例,30.00%),EB病毒检出比例高于普通重症组(χ2=6.909,P=0.009)。结论下呼吸道流感危重症多见于5岁以下儿童,夏季高发,当肺部出现湿啰音,血常规以中性粒细胞增高为主,CRP升高明显,特别是合并肺炎链球菌、EB病毒感染时需警惕危重症的发生,密切关注呼吸系统的重症肺炎、呼吸衰竭、塑型性支气管炎并发症,早期抗病毒治疗,控制合并感染,积极给予对症治疗、生命支持能改善预后。

Objective To analyze the clinical characteristics of lower respiratory tract infection of influenza virus-related critical illness in children,and provide reference for early diagnosis and treatment of the disease.Methods Thirty influenza virus-related critical cases of lower respiratory tract infection admitted to Shenzhen Children′s Hospital from October 2018 to October 2019 were enrolled in our study,and the clinical data were compared with influenza virus-related common severe cases with lower respiratory tract infection.Results We reported that 63.33%of children with critical illness were less than five years old,and most of them were male(25 cases,83.33%).The incidence of critical cases in the summer was significantly higher compared with common severe cases(χ2=7.050,P=0.008).In addition,pulmonary rales were the most common lung signs in critical cases(χ2=5.222,P=0.022),and the incidence of severe pneumonia increased significantly(χ2=32.651,P<0.001).Besides,we noticed that 60.00%of critical cases had respiratory failure,and the prevalence rates of plastic bronchitis among critical cases significantly increased(χ2=7.797,P=0.005).The absolute counts of neutrophil and the proportion of C-reactive protein in critical cases were higher than those in common severe cases(Z=-3.805,P<0.001;χ2=5.833,P=0.016).We also found that 30.00%of critically-ill cases had Streptococcus Pneumoniae in lavage,of whom Epstein-Barr(EB)virus detection rate was higher than that of common severe cases(χ2=6.909,P=0.009).Conclusion Critically ill cases of lower respiratory tract with influenza virus infection are more common in children under five years old.These cases mainly occur in summer.When patients with lung rales,the absolute counts of neutrophil and the C-reactive protein increased significantly,and specifically with streptococcus pneumoniae and EB virus infection,which are more likely to progress to severe cases.Severe pneumonia,plastic bronchitis and respiratory failure need to be close monitored as the serious complications of critical illness.Early anti-influenza viral and anti-bacterial treatment,as well as active symptomatic life support can improve the prognosis of the disease.