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目的探讨江西地区甲型H1N1流感重症及危重症患儿的临床及流行病学特征。方法对甲型H1N1流感重症及危重症患儿22例的流行病学、临床、实验室检查、影像学资料、治疗及转归进行记录,并总结分析。结果 1.危重症13例,重症9例;男16例,女6例;平均年龄3岁9个月,其中≤5岁18例。22例中有流感或流感样病例接触者5例(22.73%)。9例存在基础疾病。其中8例为反复喘息史,1例为结核感染。2.临床首发症状主要为咳嗽、发热、气急,气急发生在病程第1-3天,危重症组气急发生率显著高于重症组(P<0.01)。危重症组肺部啰音出现时间、入院时病程早于重症组,肺部啰音持续时间、住院天数长于重症组(Pa<0.05)。3.危重症组入院时血白细胞计数、中性粒细胞比例、血浆IgE水平明显高于重症组(Pa<0.05)。入院时血清CRP水平在重症及危重症组均高于正常值。病程1～2周危重症组血白细胞计数、中性粒细胞比例明显下降;嗜酸性粒细胞比例显著增高,与入院时比较差异均有统计学意义(Pa<0.01)。4.开始用奥司他韦治疗中位数时间为病程第4天,危重症患儿中10例使用短程小剂量甲泼尼龙治疗,11例需要机械通气治疗。开始机械通气时间为病程第2-5天,机械通气持续时间为1～5 d,二者呈显著正相关(r=0.635,P=0.036)。结论有反复喘息病史的学龄前儿童为本地区甲型H1N1流感防控重点人群,呼吸道高反应性可能是甲型H1N1流感病毒导致肺部严重病理损伤的重要基础。气急是危重症病例早期识别的重要特征。积极地抗病毒治疗、早期机械通气、早期短程小剂量糖皮质激素有助于改善危重症病例预后。
Objective To investigate the clinical and epidemiological characteristics of children with severe and critically ill A (H1N1) in Jiangxi Province. Methods Epidemiological, clinical, laboratory tests, imaging data, treatment and prognosis of 22 severe and critically ill children with influenza A (H1N1) were recorded and analyzed. Results 1. Critical illness in 13 cases, 9 cases of severe disease; 16 males and 6 females; mean age 3 years and 9 months, of which 18 cases ≤ 5 years. Among the 22 cases, 5 cases (22.73%) had contact with flu or flu-like cases. Nine patients had underlying disease. Among them, 8 cases had recurrent wheezing history and 1 case had tuberculosis infection. The main clinical symptoms of cough, fever, shortness of breath, shortness of breath occurred in the course of 1-3 days, critically ill group of emergency was significantly higher than the severe group (P <0.01). The onset time of pulmonary rales in critically ill patients was earlier than that in severe patients on admission, and the duration of pulmonary rales and hospital stay were longer than those in severe patients (Pa0.05). In critically ill patients, blood leucocyte count, neutrophil ratio and plasma IgE level were significantly higher than those in severe group (Pa0.05). Serum CRP levels at admission were significantly higher than those in critically ill and critically ill patients. Serum leukocyte count and neutrophil ratio were significantly decreased in critically ill patients with 1 ~ 2 weeks of disease course. The proportion of eosinophils was significantly increased, which was significantly different from that at admission (P <0.01). 4. Start treatment with oseltamivir median time for the first 4 days, 10 cases of critically ill children with short-term low-dose methylprednisolone treatment, 11 cases required mechanical ventilation. The duration of mechanical ventilation was 2-5 days and the duration of mechanical ventilation was 1-5 days, with a significant positive correlation (r = 0.635, P = 0.036). Conclusions Preschoolers with recurrent wheezing history are the key prevention and control agents of Influenza A (H1N1) in the region. Respiratory hyperresponsiveness may be the important basis of severe pulmonary pathological damage caused by Influenza A (H1N1) virus. Shortness of breath is an important feature of early identification of critically ill patients. Active antiviral therapy, early mechanical ventilation, early short-term low-dose glucocorticoid can help to improve the prognosis of critically ill patients.