小儿甲型H1N1流感危重症11例临床分析

目的 总结11例小儿甲型H1N1流感重症/危重症的临床特点及诊治经验.方法 对2009年11月22日至2010年2月7日收入笔者医院隔离ICU病房确诊为甲型H1N1流感重危症的11例患儿进行回顾性分析.结果 11例中,男性5例,女性6例,年龄3个月～11岁,年龄中位数为3岁,4例有基础性疾病(4/11),出现呼吸系统重危症多见于5岁以下,而出现神经系统并发症多在4岁以上;发病后至入院时间为2～7天,住院至入ICU时间为1～3天,其中4例并发重症肺炎,3例并发急性呼吸窘迫综合征(ARDS);4例并发脑病、脑炎,其中1例合并多脏器功能不全.入院后给予奥司他韦及免疫球蛋白、糖皮质激素及抗生素等综合治疗,4例行机械通气,4例降颅压处理.10例好转或治愈出院,1例放弃治疗后死亡.结论 有基础疾病及5岁以下是儿童发生重危症的高危因素,重症肺炎、ARDS多见于5岁以下,而并发神经系统症状者多见于年长儿童(>4岁),早期给予奥司他韦、呼吸支持、降颅压、抗细菌感染及免疫调节等综合治疗是降低重危患儿病死率的关键.

Clinical Characteristics of 11 Children with Severe and Critical Influenza A (H1N1) Infection

ObjectiveTo investigate the clinical characteristics of 11 children with with severe and critical influenza A (H1N1) infection. MethodsThe data of 11 severely and critically ill patient with confirmed influenza A (H1N1) in isolated ICU from November 22nd 2009 to February 7th 2010 were analyzed. ResultsEleven patient were enrolled in the study, of whom 5 cases were male,6 were female,and the median age were 3 (3monthes~11years) years old. Four patients had comorbid conditions(4/11). The children with complication of respiratory system were under 5 years, and with neurologic complications were older than 4 years. The time from onset of symptoms to hospital admission was between 2 to 7 days, and from hospitalization to ICU admission 1 to 3 days. Among 11 patients,4 had severely pneumonia, 3 had acute respiratory distress syndrome(ARDS), 4 had encephalopathy or encephalitis, and among the latter 4 patients, 1 combined multiorgan dysfunction syndrome. All patients were given oseltamivir, intravenous immunoglobulin, methylprednisolone and antibiotics. Four patient were intubated and four patient were dropped cranium pressure. Ten of 11 patients were discharged with the disease improved or cured. One patient died for giving up. ConclusionThe risk factors of severe or critical illness and death in influenza A(H1N1) are comorbid condition and under five years old children. Influenza A(H1N1)-associated severely pneumonia and ARDS occur in children aged <5 years and influenza A(H1N1)-associated encephalopathy cases occur in children aged >4 years. Early intervention of oseltamivir administration, respiratory support, coexist infection control, immunomodulation is the key to decrease the death rate of severe and critical influenza A(H1N1) virus infection.