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目的分析儿童重症甲型H1N1流感的临床特点及治疗效果。方法对2009年12月在本院甲流病房集中收治的重症甲型H1N1流感59例进行回顾性分析。全部病例入院前均取咽拭子标本进行了甲型H1N1流感病毒的病原核酸检测,观察记录患儿住院期间的临床表现、合并症特点、实验室检查、疗效及转归。结果本组患儿均不同程度出现持续高热不退,呼吸系统、血液系统、神经系统等多系统损害表现以及原有基础性疾病加重等情况。59例中发热57例,咳嗽54例,其中经X线诊断肺炎40例,诊断支气管炎14例。外周血白细胞尤其中性粒细胞数量下降56例。少数患儿有嗜睡、乏力、烦躁等神经系统症状,但均无脑脊液及头颅CT的异常。用奥司他韦口服57例,此外根据各自病情给与抗感染、输注丙种球蛋白支持治疗及其他对症治疗。57例中,1例自动出院,其余患儿均治愈或好转出院。结论儿童重症甲型H1N1流感主要以呼吸系统症状为主,口服奥司他韦以及适当的抗感染、输注丙种球蛋白等综合性治疗有确切的疗效。
Objective To analyze the clinical features and therapeutic effects of severe H1N1 influenza in children. Methods A retrospective analysis was carried out on 59 cases of severe type A (H1N1) influenza in intensive care unit admitted to our hospital in December 2009. All patients were admitted to the hospital before the throat swab specimens for influenza A H1N1 influenza virus pathogenic nucleic acid test was recorded during the hospital records of children with clinical manifestations, complications, laboratory tests, efficacy and outcome. Results The patients in this group showed varying degrees of sustained high fever, respiratory system, hematological system, nervous system and other multi-system damage, as well as the exacerbation of the original basic diseases. 59 cases of fever in 57 cases, cough in 54 cases, of which 40 cases of pneumonia by X-ray diagnosis of bronchitis in 14 cases. The number of peripheral white blood cells, especially neutrophils, decreased 56 cases. A small number of children have drowsiness, fatigue, irritability and other neurological symptoms, but no cerebrospinal fluid and cranial CT abnormalities. 57 cases were treated with oseltamivir. In addition, anti-infectives were given according to their respective conditions, and infusion of gamma globulin supportive therapy and other symptomatic treatment were given. 57 cases, 1 case was discharged automatically, the remaining children were cured or improved discharge. Conclusion Severe influenza A (H1N1) in children is mainly characterized by respiratory symptoms. Oral oseltamivir and appropriate anti-infection and gamma globulin infusion therapy have definite curative effect.