빈호흡을 보이는 폐렴이 동반된 신종 인플루엔자 감염 소아의 임상 양상
Clinical Aspects of Pneumonia with Tachypnea in Pediatric Patients with Influenza H1N1
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목 적:신종 인플루엔자로 확진 받고 동반된 폐렴으로 입원 치료한 소아 환자들의 임상 양상, 검사 소견, 경과 과정을 조사 하였다. 방 법:모두 101명의 환자가 연구에 포함되었는데, 환자군을 빈호흡이 있으면 1군(66명), 없으면 2군(35명)으로 나누고, 환자 자료 수집을 위해 의무기록을 후향적으로 재검토하였다. 결 과:1군에서는 2군보다 환자군의 나이가 많았고,(중간값 7세: 4세, P<0.001) 59.0%가 6-8세였다. 1군 환자 16명(24.2%)이 기저 질환을 가지고 있었고, 대부분이 천식이었다. 하지만 나머지 50명은 과거력에서 특이소견 없이 건강했다. 입원 당시 대기중 산소 포화도는 1군이 평균 92%로 2군(98%)보다 의미있게 낮았고,(P<0.001) 그 중 42명(63.6%)이 산소 포화도 92% 이하의 저산소증을 동반했다. 혈액 검사에서는 2군(11명)에 비해 1군(59명)이 의미있게 높은 림프구 감소증 빈도를 보였다.(P<0.001) 치료 방법에서는 1군이 스테로이드 사용 28명, 주사용 면역 글로블린 투여 16명, 및 산소 치료 48명으로, 스테로이드 사용과 산소 치료의 빈도가 2군보다 의미있게 높았다.(P< 0.001, P=0.055, P<0.001)결 론:결론적으로 신종 인플루엔자는 6세 이상의 소아와 관리가 잘 되지 않은 기저질환을 가진 환자군에서 폐렴을 동반한 심각한 수준의 호흡기 문제를 일으킬 수 있었다. 향후 다기관 공동으로 2009년에 유행한 신종 인플루엔자 감염 양상에 대한 조사 연구가 필요할 것으로 생각된다.
Abstract
Purpose:We evaluated the clinical/laboratory characteristics and progress of pediatric patients hospitalized for pneumonia and laboratory-confirmed H1N1 influenza infection. Methods:A total of 101 patients were enrolled. They were divided into 2 groups: group 1 with a fast respiration rate for age (n=66) and group 2 with an appropriate respiration rate for age (n=35). We retrospectively reviewed the medical charts to collect data on the hospitalized patients. Results:Patients were significantly older in group 1 than in group 2 (median age, 7 vs. 4 years, P<0.001) and 59.0% were between 6 and 8 years of age. Sixteen patients (24.2%) in group 1 had underlying medical conditions, most of whom had asthma, and 50 were previously healthy. Oxygen saturation on admission day was significantly lower in group 1 than in group 2 (92% vs. 98%, P<0.001) and 42 patients (63.6%) in group 1 had hypoxia (oxygen saturation ≦ 92%). The frequency of lymphopenia was significantly higher in group 1 than in group 2 (n=59 vs. 11, P<0.001). Some patients in group 1 received systemic corticosteroid therapy, intravenous immunoglobulin infusion and oxygen supplement (n=28, n=16, n=48, respectively). The frequency of systemic corticosteroid therapy and oxygen supplement was higher in group 1 than in group 2 (P<0.001 for each). Conclusion:H1N1 influenza infection complicated by pneumonia can cause severe illness in previously healthy children more than 6 years old and in children with uncontrolled allergic disease. Multi-center studies are needed to evaluate the clinical and epidemiologic characteristics of pediatric patients with 2009 H1N1 influenza.
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