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目的探讨湘西自治州少数民族地区甲型H1N1流感危重患儿临床特点及诊疗体会。方法回顾性分析资料完整的本院儿科住院4例甲型H1N1流感危重患儿临床表现、实验室检查及影像学资料。结果 4例患儿早期无特异性表现,均为流感样症状。3例发热,1例病初体温未测,4例均咳嗽,少量痰液,病情加重可出现咳嗽加重,均有呼吸困难,无腹泻呕吐,2例3d未排大便,伴腹胀;随着病情进展都有多脏器功能不全,其中以肺脏受累最为突出。实验室检查:白细胞计数正常、降低或升高,多有肝肾功能异常。X线胸片提示双肺均有广泛受损害,表现为大片状高密度影。结论甲型H1N1流感危重患儿病情凶险,进展迅速,病死率高。因此,为了降低发病率,特别是降低危重症发病率,必须加强小于5岁的农村儿童甲型H1N1流感疫苗接种及防控工作,同时注重针对合并营养性缺铁性贫血儿童的早期治疗。早发现,早诊断,早期综合治疗,是降低甲型H1N1流感危重症病死率的关键。
Objective To investigate the clinical features, diagnosis and treatment of critically ill children with influenza A (H1N1) in minority areas in western Hunan Province. Methods The clinical manifestations, laboratory tests and imaging data of 4 critically ill children with influenza A (H1N1) in pediatric hospital were retrospectively analyzed. Results There were no specific manifestations in early stage of four cases, all of which were flu-like symptoms. 3 cases of fever, 1 case of early body temperature was not measured, 4 cases were coughing, a small amount of sputum, aggravating the condition may increase cough, both dyspnea, no diarrhea and vomiting, 3d cases of stool without bloating, with abdominal distension; Progress has multiple organ dysfunction, of which the most prominent lung involvement. Laboratory tests: normal white blood cell count, decreased or increased, and more liver and kidney dysfunction. X-ray showed that both lungs are widely damaged, manifested as large, high-density film. Conclusion Influenza A (H1N1) critically ill children are in dangerous condition, with rapid progress and high mortality rate. Therefore, in order to reduce morbidity, especially to reduce the incidence of critical illness, it is necessary to strengthen the vaccination and prevention and control of influenza A (H1N1) in rural children less than 5 years old. At the same time, we should pay attention to the early treatment of children with combined nutritional deficiency of iron deficiency anemia. Early detection, early diagnosis, early comprehensive treatment, is to reduce the critical fatality rate of influenza A H1N1 influenza.