11casesofchildrenwithseverecasesofinfluenzaA(H1N1)ClinicalAnalysis-毕业论文翻译

1、11 cases of children with severe cases ofinfluenza A (H1N1) Clinical AnalysisAbstract Objective: To describe (H1N1) influenza in children with severe clinical symptoms characteristic. Methods: The hospital in November 2009 - January 2010were treated 11 cases of Influenza A H1N1 influenza in children

2、 with severe, retrospective study, to understand Clinical features and to provide some clinical experience.Results: 11 cases of children in 8 males and 3 females, age ranged from 2 years to 8 years old in January, May, onset of symptoms are cough, fever, cough sputum, all patientshad chest X-ray lun

3、g infection disease, to take specific treatment were cured. Conclusion: Children with severe cases of influenza A (H1N1) age of onset and atypical symptoms, bacterial infection may be combined, for antiviral therapy comprehensive treatment can achieve better results.Keywords Influenza A H1N1 influen

4、za virus, severe pneumonia, sepsisAbstract Objective: To describe the clinical features1of children severe pneumonia of influenza A (H1N1) infection. Methods: The epidemiological information andclinical characteristics of 11 children severe pneumonia of influenza A (H1N1) infection admitted in Zhong

5、shan CityPeople s Hospital fromNovember1st,2009 toJanuary1st, 1010 werereviewedbydescriptiveepidemiology.Results: There were 8 male and 3femalecasesfrom 2years, 1 monthsto 8 years, 5 monthsinage. Themainsymptoms were fever and cough with sputum. AbnormalappearanceofchestX-rayincludedincreasedbroncho

6、vascularshadows,pneumonia,withorwithoutpleuraleffusion.Allofthosecaseswerecuredafterspecifictherapy.Conclusions:ItiseasytomisdiagnoseChildrenseverepneumoniaofinfluenzaA(H1N1)infectionasthereisnogeneral firstsymptoms andage.Amalgamativebacteriumis probablyaffectedonthefoundation with severe pneumonia

7、 of influenza A (H1N1)infection.Symptomsinthemajorityofpatientsdisappeared after specific treatment.Keywords: Swine-origin influenza A (H1N1) virus, Severe pneumonia, Sepsis2Influenza A H1N1 influenza, also known as swine flu,in March 2009 the first outbreaksin Mexico and quicklyspread worldwide 1In

8、2009 June11, theWorld HealthOrganization (WHO announced (H1N1) upgrade the levelof influenzapandemicalertto6,entertheglobalpandemic phase by imported cases, the Mainland of Chinain May 2009 found that the first case of H1N1 influenzapatients,andwiththe progressoftheepidemic,severeand began deaths as

9、 of March 17, 2010, 31 provinces inChina smainlandreportedatotalof127,427 cases ofconfirmed cases, which has reported cases of critically illpatients with severe and 8320 cases, 796 cases of deaths.children becauseof poorimmunity,itis influenzaH1N1influenza in susceptible people, the occurrence of s

10、evereand a higher proportion of critically ill patients, this studyby November 2009 January - 2010 Peoples Hospital ofZhongshanCity, admittedtothe pediatricwardduringdiagnosis and treatment of 11 cases were retrospectively analyzed, evaluate the effectiveness of existing treatment options for the fu

11、ture diagnosis and treatment of children with severe summary of clinical experience.31 Subjectsandmethods1.1 Theobjectofthis study for the November 2009 January - 2010 Zhongshan People s Hospital treated 11 patients with severe Influenza A H1N1 influenza in children, so cases arein line with the Min

12、istry of Health <<Influenza A H1N1 influenza treatment program (2009 In the third edition of>> the diagnostic criteria for severe cases,and by Zhongshan City, Centre for Disease Control and Prevention using RT-PCR, throat swab for pathogen detection, confirmed confirmed c

13、ases, including four patients met diagnostic criteria for critically ill patients.1.2Datacollectionforthis studyincluded allcasesofsoaccordingto<<InfluenzaA H1N1influenza treatment program (third edition 2009>>characteristicoftheprovisionsofdatacollection,including:demogr

14、aphicdata,symptoms,signs,medicalhistory, relevant treatment of the inspection and testing,suchasthreeconventional,liverandkidneyfunction,serum ions, enzymes, blood gas analysis, CRP, ESR, serumMycoplasma pneumoniae IGM antibodies, blood culturesand other tests, and chest imaging studies, in some cas

15、es4the fluid and cellular immune test results, and treatment, such as disease outcome information.1.3 Research Methods in patients according todisease-relatedinformationcollectedtocomparethecurrenttreatmentprogram,comparingdifferenttreatment under the symptoms and signs in, the differences in diseas

16、e outcome test results to assesspatient outcomes, as such disease where the accumulation of experience.2treatmentAllcasesarereleasedbytheMinistryofHealth<<InfluenzaAH1N1influenzatreatmentprogram>>asthebasisforcomprehensivetreatment,specificprogramsinclude:nutritionalsuppo

17、rtandmaintainelectrolytebalance.anti-infectivetherapy:isstillverycommonforcommunity-acquiredinfectionspathogens,aretheconventional doseof intravenous antibiotics, antiviraltherapy:11casesof childreninaccordancewiththeMinistryofHealthannounced<<InfluenzaA H1N1influenza treatment program

18、>> given the standard5amountofoseltamivir-specificanti-viraltreatment,oxygentherapy:patientswith shortnessofbreathsymptomsaccordingto givennasal cannulaoroxygenmask,oxygen flowaccordingto thespecificdiseasecontrolinthe5 L/ min,ifsufficientoxygenisstillincreasing shortness of breath, ox

19、ygen saturation decline,then under the condition for ventilator treatment to enhance the immunity of patients: the condition of patients given gamma globulin or the recent Influenza A(H1N1) patients who were convalescent immune plasma or serum vaccination treatment. high-dose steroid pulse therapy.3

20、 Results2.1 General Information: 11 cases ofchildren in the youngest 2 years old in January, the oldest 8 years old in May, in critically ill children, the youngest 2 years old in January, the oldest 6 years and 9 months. Aredenied history of exposure to infectious diseases and other special medical

21、 history, shown in Table 1.Table 1 Demographic characteristics of childrenwith a history of the case and11 cases of children in line6with the basic values ?of diagnostic criteria for critically illpatients value Age (4.4 + -1.3 years the number of cases 4 cases in childrenGender (male / female) 8 /

22、3 age (3.8 + -1.9 yearsoldSpecialhistoryofsex(male /female)3/ 1AsthmaticbronchitistwocasesspecialmedicalhistoryJE HistoryofonecaseofvaccineOnecaseofasthmaticbronchitis3.2Clinicalmanifestationsinthisgroupofpatients,childrenwithonsetof symptomsarecough,fever,sputum,all patientshadchest X-ray lunginfec

23、tion lesions had fever, but the H1N1 influenza-related laboratory test results Some children are not typical, and its specific clinical manifestations in Table 2.Table2inchildrenduringclinicaltreatmentImaging of children with signs and laboratory test resultsofnumericalvalues?inchildrenThemainsignso

24、fadmiss (100% CK value of the normal five casesCoughand sputum three cases of six cases of elevated CK valuesHemoptysis,sputumonecase inwhichonewirein thecourse of the rapid increase in two casesVomiting and7one case of C-reactiveproteinHeadache,1caseofadmissionexaminationCRP valueincreasedfour case

25、sBlood erythrocyte sedimentation rate (ESR40 110mm /HImagingstudies(x-rayexamination)admissionexaminationin11patientsweresignificantlyincreased(100%Lunginfectionin11cases(100%detectionofserumMycoplasmapneumoniaeIGMUnilateralpneumoniain4 patients(36%positive1 cases1 caseprogressed to double pneumonia

26、 and left pleural effusionof serum sodium ion detection:Bilateral pneumonia in4 cases (10 cases 36%lowerserumsodiumWhichbilateralpneumoniaand pleuraleffusionin2casesofunilateral decreased * 1 case3.3 Therefore, treatment ofchildreninaccordancewithpre-establishedtreatmentoptions for treatment, after

27、treatment, 11 cases of childrenare upto<<InfluenzaA H1N1influenzatreatmentprogram (third edition 2009>> discharge standardswere discharged, the specific data shown in Table 3.Table 3 for treatment and prognosis of patientsTreatmentandprognosisofpatientsTreatmentofchildren

28、withdiseaseoutcomeinchildrenNutritional8support and maintain the electrolyte balance in 11 cases(100% gamma globulin 6 cases Anti-infective treatment of 11 cases (100% in 4 cases using both the recent H1N1flu patientsTypesof39.3-40.1recoverywithantibiotics or vaccination by immune plasma plasmaImipe

29、nem one case the impact of high-dose steroidtherapyCephalosporins10casesofonepatientinimproving immunity after receiving steroid pulse therapyMacrolide10casesAntiviraltherapyinchildrenwithdisease outcomeOseltamivir(standardamount of 11cases (100%)hospitalizationperiod6-25daysOxygentherapy in five ca

30、ses the symptoms improved:1 case ofshortnessofbreath,fevertreatmentwithmechanicalventilationaggravatedperiods1-12daysDiseaseoutcome in children with an average of 3.5 days, mediantime 2.5 daysGammaglobulin6 casesof imagechanges4 ofwhich were also used recent H1N1 flupatientswhoimprovedchestX-rayperi

31、od3-12daysRecoveryofimmune serum or plasma vaccine recipients an average of4.9 days, median time 4.5 daysLinks to free discussion paper download 94Influenza A H1N1 influenza as a new type of respiratory infection, the pathogen of the new H1N1 influenza virus strains, belonging to Orthomyxoviridae vi

32、rus family (0rthomyxoviridae, influenza virus, (Influenza virus A, the virus contains swine flu genes, poultry threetypes of influenza and human influenza viruses of influenza gene fragments main source of infection for theH1N1 flu patients, mainly through droplets through the respiratory tract can

33、also be transmitted through the mouth, nose, eyes, mucous membranes, etc. direct or indirect contact. contact with respiratory secretions, bodyfluids and items contaminated by the virus may also cause infection 2 and foreign literature study indicated that children with chronic underlying diseases o

34、ccur in adultswith severe cases of H1N1 flu risk than other groups 1,3 , and our release of October 2009 <<Influenza A H1N1 influenza treatment program (third edition 2009>> prompt aged <5 years of age, especially <2 years of age are critically ill patients

35、at high risk of influenza of theH1N1 influenza a 2 This study reported 11 cases, the average age of children <5 years old, and 4 patients10maydecreaserespiratorysystemresistanceto thebasicdisease, suggesting that prevention should be strengthened for the children, there are risk factors for v

36、accinated children can choose their means of providing resistance to virus transmission.LouieshortnessofbreathandotherresearchindicatesthattheH1N1fluimportantsigns, andacuterespiratorydistresssyndrome(ARDSarecommonincriticallyill H1N1flusyndromeandcauseofdeath4,while thefirst symptomofchildreninthis

37、groupmainlyfever, followed by cough, headache and other symptoms,nosymptomswithshortnessofbreathasthefirst,suggestingthatchildrensH1N1 flusymptomsarenottypical,wasthediversityofeach,butifpatientsexperienceshortnessofbreathsymptoms,diseaseprogressionismorequickly,childreninthisgroup, 1patient had sym

38、ptoms of rapidly increasing shortness ofbreath,respiratorydistresssymptoms,needformechanicalventilation,therefore,toshortnessofbreathasthemainperformanceofchildrenwithsevereH1N1influenzashouldbecloselyobservedinpatientswith11respiratory conditions, to prevent death or serious condition.Inlaboratoryt

39、ests,thepatients in thisgroupthere are some existing studies have reported differences,JainS studyfoundthatpatientswith severeInfluenzaAH1N1 influenza can reduce the occurrence of lymphocytesandneutrophils5,itmayhavemergedwiththemostchildrenbacteriaand/ormycoplasmainfection,butlaboratory tests in th

40、is group of children with no reductionin lymphocytes,morecommonneutropenia,11casesofchildrenwithneutropeniain6cases(54.5%oftotalnumber of cases, the decrease neutrophils may be due toinfluenzavirusinfectionisrelatedtoprotectionmechanisms6Whentheinfluenzavirusdestroyneutrophilsprotectionfactorsleadto

41、neutropenia,agranulocytosisandeventhecase, thisphenomenoninthe<<InfluenzaAH1N1influenzatreatmentprogram(thirdedition2009>>notmentioned,hencetheneedforfurtherepidemiologicalstudiestodetermine whether neutrophils lack of influenza A H1N1 influenza as a severe clinical featu

42、res.12Inthetreatmentprogram,the childreninthisgroupareinlinewiththeMinistryofHealth<<InfluenzaAH1N1influenzatreatmentprogram(third edition 2009>> guidance on the treatment ofneuraminidaseinhibitorswithantiviraltherapy,and<<program>>inconsistent

43、isduetostartingthis group ofpatientswith atypicalsymptoms,whentoclinicalcasesofhighlysuspectedInfluenzaA(H1N1)criteria(feverlastmorethanthreedaysorshortnessofbreath,thecourseisover48hours,failedto<<scheme>>suggesttheonsetofcriticalillness as far as possible within 48 hour

44、s of oral oseltamivir(Tamiflufivedaystreatment,butalsotoobtainbetterclinical results, this group of children with standard 5-dayregimendidnotappearduetoprotractedillnessandadditional medication needs to be extended time cases.In addition to antiviral treatment, this group ofchildrenweregivenanti-bac

45、terialtreatmentabroadforthe H1N1 flu deaths of some studies have found that lungbacterialmixedinfectionrateof30%,andbacterial13infectionsmay also be sicker One importantreason7.The patients check in addition to one case of pathogenicMycoplasma pneumoniae IgM antibodies,the remainingcases,althoughthe

46、line ofsputumcultureand bloodculture, but could not find a clear basis for mixed infection,but laboratory tests found 11 cases of children in the CRPincreasedsignificantly,suggestingthatchildrenarevaryingdegreesof systemicinflammatoryresponseandpossiblebacterialinfection.Thus thisgroupof patientsaft

47、eradmissionweregivencephalosporins,macrolidesand other antibiotics combined with anti-infection.For critically ill patients are using steroid pulsetherapy,consideringthereisnoclearbenefitsandpossible side effects of existing treatment programs and related reports is not recommended application of la

48、rge doses of hormone therapy, but in this group of children in our 1 case of fever, shortness of breath and chest as the main X-ray changes and the rapid progress of the children was the diagnosis and treatment process, the reference to children with severe acute respiratory distress syndrome diagno

49、stic criteria and treatment program (trial 8, in the14broad-spectrum anti- infection based on the early use ofglucocorticoid - methylprednisolone pulse therapy for 3 days, shortness of breath, fever and chest symptoms markedly improved performance, results were satisfactoryand did not find adverse reactions of corticosteroids, suggesting that the performance of the emergence of ARDS Children can try the early use of high-dose steroidpu