小儿甲型H1N1流感危重症诊治体会

目的 探讨小儿甲型H1N1流感危重症患儿的发病特点及治疗措施.方法 2009年10月5日至11月15日期间我院PICU收治11例出现甲型H1N1流感样症状合并重症肺炎、急性呼吸窘迫综合征(ARDS)患儿,对其发病特点、治疗方法及转归等资料进行分析.结果 11例甲型H1N1流感样患儿合并重症肺炎、ARDS,其中6例经咽拭子检测甲型H1N1流感病毒核酸阳性.患儿平均年龄3.9岁(10个月～11岁).所有患儿都表现为发热和呼吸系统症状,从发病到出现危重症状的时间为5～10 d.6例行机械通气治疗.目前全部病例存活,无一例死亡.6例机械通气患儿已有4例安全脱机,2例仍在机械通气中.结论 重症甲型H1N1流感患儿病初为流感症状,无特殊临床表现;病情可在短时间内迅速加重,重症患儿以呼吸困难、低氧血症为突出表现;婴幼儿可伴有嗜睡、烦躁等神经系统症状;重症患儿肺部病变广泛,进展迅速,可在短时间内出现纵隔及皮下气肿、ARDS甚或肺出血并随之出现多脏器功能障碍综合征.

The characteristics and treatment of critically ill children with 2009 influenza A(H1N1)

Objective To describe baseline characteristics,treatment,and outcomes of consecutive critically ill children in PICU of Shengjing Hospital China Medical University that treated the majority of such patients with confirmed,probable,or suspected 2009 influenza A(H1N1). Methods Observational study of 11 critically ill children with 2009 influenza A(H1N1) between October 1 and November 18,2009. Symptoms, comorbid conditions, illness progression, treatments, and clinical outcomes were collected using a piloted case report form. Results The average age of 11 patients was 3.9 years (10 months～11 years). All presented with fever and respiratory symptoms. Time from the onset of the disease to PICU admission was 5～10 days,and 6 patients with severe acute respiratory distress syndrome and refractory hypoxemia. No patients died until now. Six patients who received mechanical ventilation had greater initial severity of illness,worse hypoxemia,higher creatine kinase levels,higher creatinine levels,and ongoing organ dysfunction. Conclusion Critical illness from 2009 influenza A (H1N1) occurred in children was associated with severe pneumonia,acute respiratory distress syndrome and ongoing organ dysfunction.