摘要
目的探讨儿童流感病毒感染的死亡原因,以期提高诊疗水平。方法收集2017年11月至2018年4月首都医科大学附属北京儿童医院重症医学科收治的确诊流感危重症中的死亡病例,根据不同病毒类型分组,分析其临床特征及死亡原因。结果共纳入19例,其中<5岁15例(78.95%),<2岁9例(47.37%)。入院时二代小儿死亡指数评分中位数为72.7%。确诊H1N1流感11例,乙型流感8例。6例存在基础病。患儿均有发热、咳嗽、呼吸困难,昏迷13例。17例出现肺炎,11例并重度急性呼吸窘迫综合征(ARDS),3例并气漏综合征;8例并流感相关性脑病(IAE)。10例(52.63%)死于重度ARDS,7例(36.84%)死于IAE,1例(5.26%)死于多脏器障碍,1例(5.26%)死于重症心肌炎、心源性休克。比较ARDS和IAE患儿自发病到死亡时间[15(4,22) d比3(2,8) d],差异有统计学意义(Z=-2.063,P=0.039)。在因重度ARDS死亡的患儿中,H1N1流感组以<2岁为主,乙型流感组均≥2岁。死于IAE的患儿均≥1岁。6例(31.58%)存在细菌共感染,以革兰阳性球菌为主。患儿均使用神经氨酸酶抑制剂治疗,发病至首次用药平均时间为5 d。结论流感病毒感染死亡患儿主要死亡原因为重度ARDS及IAE。相对于ARDS,IAE病情进展更加急骤。
Objective To analyze the cause of fatal cases in children with confirmed influenza virus infection, and in order to improve the level of diagnosis and treatment. MethodsDeaths in critical illness of influenza were co-llected from November 2017 to April 2018 in Pediatric Intensive Care Unit of Beijing Children′s Hospital, Capital Medical University.The clinical characteristics and causes of death were retrospectively analyzed according to the different virus types. ResultsA total of 19 cases were included.Fifteen cases (78.95%) were less than 5 years old and 9 cases (47.37%) were less than 2 years old.On admission, the median score of pediatric index of mortality 2 was 72.7%.There were 11 cases of influenza H1N1 and 8 cases of influenza B. Six cases had underlying diseases.All patients had fever, cough and dyspnea.Thirteen patients had coma.Seventeen cases had pneumonia, 11 cases had severe acute respiratory distress syndrome(ARDS), 3 cases had air leakage syndrome and 8 cases had influenza-related encephalopathy(IAE). Ten cases (52.63%) died of severe ARDS, 7 cases (36.84%) died of IAE, 1 case(5.26%)died of multiple organ dysfunction, and 1 case(5.26%)died of severe myocarditis and cardiogenic shock.There was statistical difference in the time from onset to death between the ARDS group and IAE group[15(4, 22) d vs. 3(2, 8) d](Z=-2.063, P=0.039). Among the children who died of severe ARDS, most patients in influenza H1N1 group <2 years old, while those influenza B group ≥2 years old.All children who died of IAE were all ≥1 years old.Six cases(31.58%)had bacterial infection, mainly gram-positive cocci.All patients were treated with neuraminidase inhibitors.The average time from onset to the first time of medication was 5 days. ConclusionsSevere ARDS and IAE are the main causes of death in children with influenza virus infection.Compared with ARDS, the condition of children with IAE worsened more rapidly.
作者
刘珺
王荃
钱素云
高恒妙
曾健生
贾鑫磊
李峥
Liu Jun;Wang Quan;Qian Suyun;Gao Hengmiao;Zeng Jiansheng;Jia Xinlei;Li Zheng(Pediatric Intensive Care Unit, Beijing Children′s Hospital, Capital Medical University, Beijing 100045, China;Department of Emergency, Beijing Children′s Hospital, Capital Medical University, Beijing 100045, China)
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2019年第2期134-138,共5页
Chinese Journal of Applied Clinical Pediatrics
基金
北京市医院管理局儿科学科协同发展中心儿科专项重点项目(XTZD20180504).
关键词
流感
死亡病例
危重症
儿童
Influenza
Fatal case
Critical illness
Child
