儿童传染性非典型肺炎临床诊治体会(附6例临床病例报告)

Clinical presentation and outcomes of the Severe Acute Respiratory Syndrome in Children

目的 总结分析儿童传染性非典型肺炎 (非典 )的临床表现特点。 方法 分析 6例儿童传染性非典型肺炎流行病学史、临床症状、体征、实验室检查结果和治疗转归。 结果 6例患儿年龄 3个月～ 12岁 ,男女各 3例 ,均为家庭密切接触发病 ,潜伏期 2～ 12d ,发病后未再感染其密切接触者。临床主要表现为发热和咳嗽。腋温热峰 38 3～ 40 3℃ ,均持续 1周以上。多为不规则高热。伴轻度咳嗽 ,入院时外周血WBC总数多低于 5 0× 10 9/L ,以淋巴细胞分类为主 ;全部患儿胸部X片均有肺部不对称性、多叶局灶性浸润性阴影 ,多出现在发热后 3～ 5d ,多为双侧者 ,也可先为单侧 ,后发展为双侧 ,病变随病程进展而加重 ,多在病程 7d左右达高峰。全部患儿在未吸氧下血氧饱和度均在 95 %以上 ,1～ 5升 /分氧流量吸氧下达 97%～ 10 0 %。经治疗后全部临床痊愈出院 ,发热持续时间平均 8d ;胸片肺部炎症阴影明显吸收好转平均 2周。 结论 本组儿童非典均为家庭密切接触感染 ,感染后再传染给他人的传染力低 ;临床症状体征主要表现在呼吸系统 ,与成人患者比较 ,病情较缓和 ,较少发生呼吸衰竭和侵犯呼吸系统以外的组织器官 ,预后良好 ;

Objectives To describe the clinical characteristics and short-term outcomes of SARS in children in Guangzhou area.Methods Six cases of children with SARS were retrospectively reviewed. They were admitted to Guangzhou Children Hospital in Guangzhou from Feb,11 to May 13,2003, with a diagnosis of SARS.Their epidemical, clinical, laboratory and chest radiological characteristics were analyzed.Results The ages were 3 m～12 y, 3 males and 3 Females, all of them were exposed to SARS in family setting. Features of the clinical examination most commonly found in these patients at admission were fever (6/6) and cough (4/6). Common laboratory features included decreased total leukocyte count and elevated platelat count. All patients had abnormal chest radiographs.The primary abnormalities were air-space patchy infiltrates shadows. Ill-defined patchy consolidation, 2 of these patients had progressive consolidative changes on serial chest radiographs but all complete resolutions were achived between one week and one month.Conclusion Contrast to the experiences reported among adults that SARS carries a very high infectivity rate, all children with SARS had a history of close contacts with cases. But there was no evidence that they had spread the infections to other persons.Our preliminary data suggest that young children develop a milder form of the disease with a less-aggressive clinical courses than do adults. Features of the clinical examination most commonly found in these patients at admission were limited on respiratory symptoms.