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目的探讨儿童重症、危重症甲型H1N1流感的临床特点和诊疗体会。方法对河北省儿童医院PICU自2009年11月4日—2010年1月1日收治的甲型H1N1流感重症、危重症确诊病例共21例进行回顾性分析,包括流行病学特点、临床特征、治疗、转归等。结果 21例患儿均无明确接触史,病程中均有发热、咳嗽等流感样症状,突出特点为很快出现呼吸发憋或喘息,均有鼻翼扇动、三凹征、肺部啰音,症状重、体征轻。实验室检查:白细胞数可增高或不高。CRP及心肌酶可不同程度增高,X线胸片:多为肺纹理增多或片状渗出影,个别病例肺部病变在短时间内呈游走性变化。21例患儿经早期抗病毒、抗其他病原体感染、抗炎、对症及支持等综合治疗,均痊愈出院。结论儿童甲型H1N1流感起病急,进展快,重症、危重症病例死亡风险高,早期诊断、早期隔离治疗是降低病死率的关键。
Objective To investigate the clinical features and diagnosis and treatment of influenza A (H1N1) in children with severe and critically ill children. Methods A retrospective analysis was performed on 21 confirmed cases of severe and critically ill patients with influenza A (H1N1) in the PICU of Children’s Hospital of Hebei Province from November 4, 2009 to January 1, 2010, including epidemiological characteristics, clinical features, Treatment, outcome and so on. Results There was no clear history of exposure in all 21 cases. All the patients had flu-like symptoms such as fever and cough during the course of their illness. The outstanding features were rapid onset of breath, wheezing, nasal flaps, triple recess sign, pulmonary rales, symptoms Weight, signs of light. Laboratory tests: white blood cell count may be increased or not high. CRP and myocardial enzymes may be increased to varying degrees, X-ray: mostly increased lung tissue or sheet exudate, lung disease in some cases were migratory changes in a short period of time. Twenty-one infants were cured by early anti-virus, anti-other infection, anti-inflammatory, symptomatic and supportive treatment. Conclusion Influenza A (H1N1) in children with acute onset, rapid progression, severe, critically ill patients with high risk of death, early diagnosis and early isolation treatment is the key to reduce mortality.