【作者】 李芳；

【导师】 邢嵘；

【作者基本信息】 大连医科大学 ， 病理学与病理生理学， 2010， 硕士

【摘要】 目的：通过临床观察研究小儿呼吸道感染对其他器官功能的影响,以了解不同程度及类型小儿呼吸道感染对其它器官功能损伤程度是否不同,以及新出现病毒引起大流行时的应对措施,指导临床应用保护相关器官功能药物,及早防病治病。方法：选取2009年10月-2010年1月以小儿呼吸道感染为诊断就诊于大连市金州区第一人民医院儿科的住院及门诊治疗的52名小儿作为研究对象,其中上呼吸道感染患儿15例,肺炎(包括重症肺炎)患儿20例,甲型H1N1感染患儿17例。对所有患儿的临床资料及辅助检查资料进行整理分析,包括所有患儿都于第二日清晨采空腹静脉血,进行血细胞检测、生化肝功、心肌酶谱检查,选择性做胸部正位片、心电图等检查,记录每个患儿上述所有检查结果及入院日期、年龄、性别等一般情况,临床症状、体征、治疗方案、转归及预后资料,进行综合分析。统计资料采用SPSS10软件系统,以P<0.05为标准差并有统计学意义。结果：1.上感组、肺炎组、甲型H1N1流感组的血清磷酸肌酶同功酶(CK-MB)值,平均值分别是19.15±5.66U／L、25.52±13.43U／L、20.72±8.98U／L,两两比较,P<0.01,有统计学意义。2.上感组、肺炎组、甲型H1N1流感组的谷丙转氨酶(ALT)值,平均值分别是30.15±18.76U／L、43.52±13.42U／L、48.28±15.88U／L,两两比较,P<0.01,有统计学意义。3.本研究资料中男性患儿27例,发病比例为51.92%,女性患儿25例,发病比例为48.08%,不同性别发病率相近,无统计学意义。4.本研究资料中年龄范围6个月-13岁,平均年龄6.35岁。低龄儿易患肺炎(重症肺炎),易于对其它器官功能发生影响,随年龄增长,易于患上呼吸道感染,发生其它器官功能损害机率减少。5.本研究资料中呼吸道系统以外并发症共11例,心肌损伤3例,中性粒细胞减少症8例。6.治疗：三组病例根据临床症状及实验室检查结果给予正规治疗,确定病毒感染者均给予抗病毒治疗,白细胞升高者加用抗生素药物,肺炎患者给予抗感染对症治疗,效果显著,疗程为3-12d,治愈出院,预后良好。结论：1.小儿呼吸道感染可累及其它系统,感染程度越重,影响越明显。仅为上感累及较轻,肺炎患者累及明显,其中心肌酶谱变化最为明显。2.不同程度小儿呼吸道感染在发病率上无性别差异。3.不同程度小儿呼吸道感染发病年龄呈一定规律,随年龄增长肺炎患病率有下降趋势,多患普通上呼吸道感染。4.肺炎引起其他系统损伤发病率高,但预后尚好,无死亡病例,无后遗症。5.甲型H1N1流感起病急,进展快,可引起严重并发症,但如早期发现,正确治疗,效果佳,需要重视但不必过度恐慌。6.呼吸道感染应用抗感染治疗效果好,对于甲型H1N1流感患者,抗病毒药物效果显著,治疗同时如辅以调节免疫等对症治疗方法,可提高疗效,缩短病程。更多还原

【Abstract】 Objective:To study the effects on other organ function with children respiratory tract infection by clinical observation. To explore the relation in organ function damage to different types of childhood respiratory tract infection and find the response to the emerging pandemic virus and guide the clinical application of drugs for protection organ function, preventing and curing disease as soon as possible.Methods:Fifty-two children who diagnosed with respiratory tract infection in pediatrics of The First People’s Hospital of Dalian Jinzhou District from October 2009 to 2010 in January were collected for the study. Among of all,15 patients with upper respiratory tract infection,20 patients with pneumonias (including severe pneumonias),17 patients with influenza H1N1 infection. The venous blood of all patients were collected in the morning on the second day for blood cell analysis, assay biochemical liver function and myocardial enzyme. Anteroposterior chest X-ray and electro-cardiogram were examined selectively. We investigate against clinical data and auxiliary examination, record all the test results for each patient and the date of admission, age, gender and other general and clinical symptoms, signs, treatment, prognosis and prognostic information to comprehensive analysis. The data were analyzed in statistic software of SPSS 10, and the value of p<0.05 was regarded as statistical significance.Results:1. In the upper respiratory tract infection group, the pneumonia group and the influenza H1N1 infection group, the value of CK-MB is 19.15±5.66 U/L,25.52±13.43 U/L,20.72±8.98 U/L. Pairwise comparisons, the results show that P<0.01, there are statistical significance.2. In the upper respiratory tract infection group, the pneumonia group, the influenza H1N1 infection group, the value of ALT is 30.15±18.76 U/L, 43.52±13.42 U/L,48.28±15.88 U/L. Pairwise comparisons, the results show that P<0.01, there are statistical significance.3. In the three groups, there are 27 male children, the incidence rate is 51.92%, and 25 female children, the incidence rate is 48.08%. The results show that the incidence of the disease is analogic in different gender, the difference has no statistical significance.4. The age distribution in the three group is from 6 month to 13 years old, and the average value is 6.35 years.5. There are 11 patients with ex-respiratory system complications,3 patients with myocardial damage, and 8 patients with neutropenia synd-rome.6.Treatment:According to clinical symptoms and laboratory examin-ation results, supply three groups regular treatment:patients with virus infection were given antiviral treatment, patients with WBC steping-up were add to antibiotics, patients with pneumonia were given anti-infection symptomatic treatment. The effects are significant and eusemia. All patients were cured when leave hospital, and the course of treatment is 3-12 day.Conclusion:1.Childhood respiratory tract infection may involve other organ systems easily, the more severe infection, the more obvious involvement. The upper respiratory tract infection involved less, while the pneumonia involved obviously. The change of myocardial enzyme is the most ob-viously.2. There are no sex differences in the three groups patients.3. The age of onset distribute regularly:follow the increase of age the incidence rate of pneumonia is decline, and most patients with common upper respiratory tract infection.4.Pneumonia cause a high incidence of injury on other organ systems, but it has a good prognosis, without fatality case and sequelae.5.The influenza H1N1 onset emergency and progression fasting, it can cause severe complication. But if discovery early and cure correcetly, the effect is excellent. We should pay more attention for it, but do not panic over.6.Application of anti-infection treatment of respiratory tract infection have a good effect. For patients with influenza H1N1, the effect of antiviral drugs is significant. It can improve the efficacy and shorten course of disease, if supplemented by regulation of the immune and other symoto-matic treatment while treatment.更多还原