单中心1 726例住院婴儿急性下呼吸道感染临床流行病学调查

目的 调查复旦大学附属儿科医院（我院）住院婴儿急性下呼吸道感染（ALRIs）的流行情况及临床表现，比较分析不同严重程度ALRIs的临床特征。方法对入住我院的≤1岁的ALRIs患儿进行回顾性调查，分为重症组和轻中症组，采集人口学特征、临床表现、辅助检查、病原学、治疗情况、预后和疾病负担等信息。结果 ①2011年3月1日至2012年2月29日1 726例ALRIs病例进入本文分析，占同期≤1岁住院患儿的25.3%，流行高峰主要集中在秋冬两季。重症组<6个月患儿、低出生体重儿和早产儿比例高于轻中症组。②主要临床表现为咳嗽 (70.3%)、发热 (12.2%)，重症组气促、发绀、呼吸暂停的发生率高，分别为18.1%、8.2%、24.6%。③血气分析发现重症组较轻中症组患儿存在高PaCO2，低PaO2和SaO2；91.3%的ALRIs婴儿X线胸片出现不同部位渗出性病变和(或)局限性气肿或心缘模糊。④72.4%ALRIs患儿病原体检查阳性，以呼吸道合胞病毒（RSV）为主 (52.9%) ，重症组RSV、细菌及混合感染比例高。⑤重症组69.5%患儿合并基础疾病，主要为先天性心脏病、高胆红素血症、支气管肺发育不良、呼吸道畸形及营养不良。⑥ALRIs患儿住院天数中位数为9 d，住院费用中位数为6 864元。重症组住院天数及住院费用均高于轻中症组。结论 重症ALRIs在小婴儿中发生率高，RSV为主要病原；多存在基础疾病，疾病负担较重。

Clinical epidemiological analysis of acute lower respiratory tract infections in 1 726 hospitalized infants in single center

Objective To investigate the epidemiology and clinical manifestation of acute lower respiratory tract infections (ALRIs) in hospitalized infants，and to analyze the clinical characteristics of severe ALRIs. Methods Information about ALRIs for infants was collected who were admitted to Children's Hospital of Fudan University from March 1st, 2011 to February 29th, 2012. Patient information included demographic characteristics, clinical presentation, accessory examination, etiology, treatment, prognosis, and disease burden. Results (1) A total of 1726 children with ALRIs were included in this study, comprising 25.3% of hospitalized infant patients, with peak proportion in autumn and winter. There were more preterm, low-birth-weight and under-six-month infants in severe ALRIs group. (2) The main clinical symptom characteristics of ALRIs infants were cough (70.3%) and fever (12.2%). Severe ALRIs infants commonly had tachypnea, cranosis and apnea. (3) The blood gas analysis showed elevated PaCO2and reduced PaO2 and SaO2 in the severe ALRIs infants. Among all ALRIs infants, 91.3% patients had confirmed pneumonia by X-ray. (4) The etiologic agents were identified in 1249 (72.4%) ALRIs infants. Respiratory syncytial virus (RSV) was detected in 913 cases (52.9%), which was the most predominant pathogen. In severe ALRIs group, more RSV, bacteria and co-infection were detected. (5) 69.5% severe ALRIs patients had underlying illness, with congenital heart disease being the commonest, followed by hyperbilirubinemia, bronchopulmonary dysplasia, airway abnormalities and undernutrition. (6) The median length of hospital stay and cost of ALRIs infants in hospital were 9 days and ￥6 864 RMB respectively, where both of these figures were higher in severe cases than in mild to moderate cases. Conclusion Severe ALRIs was the common disease in hospitalized infants aged below 6 months. RSV was the most important pathogen. Severe ALRI infants had high incidence of underlying illnesses and disease burden.