âà«à à æ π åÿ À à 2009 π Á Ë â π ßæ À
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- Angelina Powell
- 5 years ago
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1 27 âà«à à æ π åÿ À à 2009 π Á Ë â π ßæ À π ÀÕ À«æ.. ÿà ß π ÿ «ßæ À π æπ åμâπ Abstract Hospitalized Pediatric Patients with Influenza A (H1N1) in Mahasarakham Hospital Homhuan C. Departmont of Pediatric, Mahasarakham Hospital Bull Dept Med Serv 2011; 36: During the beginning of the year 2009, a pandemic influenza A (H1N1) virus emerged and spread globally worldwide and also in Thailand. It is important to have a good knowledge of the signs and symptoms and progression of this disease. The early diagnosis and proper treatment we can help diminish the complications and finally death. Objective : To study the clinical manifestation and treatment of the pediatric patients who were hospitalized with influenza A (H1N1) in Mahasarakham hospital from April 2009 to December Methods : The medical records were reviewed and collected data on the patients who were hospitalized for influenza like illness and who tested positive for the influenza A (H1N1) virus with the use of RT - PCR (real-time reverse-transcriptase-polymerase-chain-reaction) assay. Results : The 107 hospitalized pediatric patients were studied, age ranged 7 months to 15 years (median age 7 years). Male to female ratio was 1:1.4 (44 male, 63 female). The underlying diseases were found in 19.6% (21/107), mostly asthma 16.8% (18/107). The proportion of patients with history of close contact influenza 2009 was 22.4% (24/107).The common symptoms were fever 100%, cough 97.2%, coryza 36.5%, sore throat 31.8%, and tachypnea 11.2%. Of the 104 patients who had chest radiographs performed, 57.0% had infiltration (mostly perihilar infiltration 45.8%). The data from laboratory investigations showed WBC less than 10,000 cells/mm3 in 89.7% (96/107) of patients, and the mean percentage of lymphocyte was 34.5 ± Of the 105 patients who received antiviral drug (oseltamivir), the treatment was initiate at the mean of 3.8 days after the onset of illness. One case required ICU admission. Secondary bacterial infection was found in 2.8% (3/107), myocarditis in 0.9% (1/ 107), hypovolemic shock in 0.9% (1/107). No patient died. Conclusions: The influenza A (H1N1) infection has become a very important respiratory tract infection, especially who had underlying disease and high risk to severe pneumonia. The symptoms and signs of this disease cannot be differentiated from the seasonal influenza, but can have a more severe ending. Key words: influenza A (H1N1), pediatric patients. ËÕß àõ Ë Õß âà«à à æ π åÿ À à 2009 ª Ë«ª» «Èß ßÀ«À æ ºŸâªÉ«π È â«ß Õ ß ß π π π «π ΩÑ «ß «π Ë «Á«Àâ Àâ μ Èß μà Ë Õß «âõπ Õ μ «μ ß â «μ ÿª ß å æ ËÕ» Õ ß ß π π π «âõπμ Õ πº ÕߺŸâªÉ«Á Ëμ ÈÕ âà«à à æ π åÿ À à 2009 â π ßæ À μ Èß μà«π Ë 1 Õπ π æ.» ß «π Ë 31 Õπ π«æ.».2553 » âõπà ß «π «π π â π «π ÕߺŸâªÉ«Á ËπÕπ ßæ
2 28 «æ å ªï Ë 36 Ë 1 - π 2554 À Ëß â «π «à ªìπ âà«à à æ π åÿ À à 2009 º μ «π π ªìπ «â««õ æ π ÿ ÕÁπ Õ Õß ÈÕ (RT-PCR) àßμ «À Ëß π Õ º» æ ºŸâªÉ«Á Ë ªìπ π È º μ «π π 107 Õ ÿ Ë 7 ªï (μ Èß μàõ ÿ 7 Õπ ß 15 ªï) æ» 44 æ»à ß 63 (1:1.4) ª μ «âõ 19.6 ª «μ º â ºŸâªÉ«âÕ 22.4 Õ ß ß π æ «à â âõ 100 à«õ Õ πè Ÿ À Á Õ ÀÕ æ âõ 97.2 âõ 36.5 âõ 31.8 âõ 11.2 μ º μ «Õ ßÀâÕßªØ μ æ π«π Á Õ «π Õ πâõ «à 10,000 åμàõ Ÿ» å μ â âõ 89.7 æ âõ Õß Á Õ «π ø å â 34.5±20.1 º μ «Õ åªõ º ª μ âõ 57.0 æ ªìπΩÑ ««È«ªÕ (perihilar infiltration) âõ 45.8 â μâ π «oseltamivir âõ 98.1 «π Ë Ë â Ë 3.8 «π Õß â º æ «à ºŸâªÉ«ËμâÕß â â ª ËÀÕºŸâªÉ««ƒμ 1 à ºŸâªÉ««μ μàæ «âõπ ªìπªÕ Õ ÈÕ 3 æ â π ÈÕÀ «Õ à««à ««1 æ «ÁÕ πè 1 ÿª ÈÕ «âà«à à æ π åÿ À à 2009 ªìπ ÀμÿÀπ Ëß Ë Õß μ ÈÕ ß πà π Á Àâ ªìπªÕ Õ â Õ â μ ÈÕ âà«à àμ ƒ Ÿ μà Àâ Ë ÿπ ß â «à æ Õ à ß ËߺŸâªÉ«Ë ª μ «Ë ßμàÕ ªìπ ªÕ Õ Ë ÿπ ß : âà«à à æ π å À à 2009 ºŸâªÉ«Á π Ë æ à Õß âà«à à æ π ÿå À à 2009 À Õ π A (H1N1) μ «ª Ë«Àâ ºŸâªÉ«ªìπ π ÈÀ â π «μ â««à 18,239 1 À ª» ß π ºŸâμ ÈÕ π È º μ «π π â«16,477 1 «μ ª â«150 1 â ß «μ Ëπμ Àπ Àâ ª π μ Ëπμ «Õß ÿ ß æ å «ß ÿ â μ Èß»Ÿπ åªø μ μ «æ âõ ªÑÕß π «ÿ â π å À à Õß âà«à à æ π åÿ À à 2009 π È π«ßªø μ (Clinical practice guideline) 1-4 π Ÿ ºŸâªÉ«Ëμ ÈÕ âà«à à æ π å À à π A (H1N1) ÕÕ μ Àâ «Ÿâ2-5 À Õ Àâ π π À ºŸâªÉ«ª π Ë«ª «Èß âπº μ μâ π «oseltamivir μ Õ π º μ«π æ ËÕªÑÕß π π È â â 𪻻 «ß π Õß π È æ ËÕ μ μ Õ ß ß π «π Ÿ μ Õ πº ªìπª πå π ΩÑ «ß ªÑÕß π ºŸâªÉ«π È Àâ ª æ Ëß Èπ μàõ ª «μ ÿ «â» «π «π πºÿâªé«á Ë â «π «à ªìπ âà«à à æ π å À à 2009 º μ «π π Ë π ßæ À À«à ß«π Ë 1 Õπ π æ.» ß«π Ë31 Õπ π«æ.» π«π 107 «π «πºÿâªé«ÿ «π Õ Õ ß ß π «âõπ º μ π«ß (Clinical practice guideline) π Ÿ ºŸâªÉ«âÀ«À à æ π å À à π A (H1N1) Õß «ß ÿ 1-4 Õ ß ºπ Ÿ Ë 1 «ÿà Ë ßμàÕ ÿπ ß: â à ºŸâ Ë «μàõ ªπ È - ÀÕ À À Õ ªÕ ÈÕ ß - À «À Õ Õ ( «âπ ºŸâ «π ŸßÕ à ß «) - Ë Àâ Ÿ μâ π πμë À Õ â Ë Ÿ μâ π π - Õ å Áß
3 29 ºπ Ÿ Ë 1 π«ßªø μ Ÿ ºŸâªÉ«Ëμ ÈÕÀ ÕÕ μ ÈÕ âà«à à æ π ÿ å À à À à π A (H1N1) Õß «ß ÿ ª» μ ÈÕ ß - ««º ª μ ß μ àπ À«π - ( à «ºŸâ ªìπæ À ) - Á Õ ÿ 15 ªï Ë ß π Õ æ π àπ «Ÿ μõ å - «º ª μ ß ª Ë ÀâªÑÕß π æ à ÈÕ - Õ ÿπâõ «à 24 Õπ À Õ «à 65 ªï - À ßμ Èß å - Õâ«π Influenza-like illness (lll): À ß ºŸâªÉ«â à ß «à ªìπ âà«à à æ π ÿå À à π A (H1N1) Õ ßμàÕ ªπ È - â > 38 Õß» à«õ/ Á Õ - Õ Õ Õ ËπÊ àπ Ÿ πè Ÿ À ª«ËÕ Õ π âõß Suspected case: À ß ºŸâªÉ«π à ΩÑ «ß Õ Õ ª «μ Ë ßμàÕ μ ÈÕ μà ß à º μ ««π π Confirmed case: À ß ºŸâªÉ«Ë º μ ««π π«à μ ÈÕ âà«æ π ÿå À à π A (H1N1) Close contact: À ß º â ºŸâªÉ«π à π 1-2 μ ºŸâ º à â Õÿª åªñõß π Ë À àπ Àπâ Õπ (mask) ˺ŸâªÉ«à à Àπâ Õπ À π Àπâ æÿ â«à Õ Õ À Õ º μ ß πè Ÿ πè ÕߺŸâªÉ«à â â ß Õ àõπ º Ÿ μ À Õª Õßμπ Õß
4 30 «æ å ªï Ë 36 Ë 1 - π 2554 Inclusion criteria ºŸâªÉ«Á ËÕ ÿ ß 15 ªï Ë â «π «à ªìπ âà«à à æ π åÿ À à π A (H1N1) À Õ æ π åÿ À à 2009 ( Ë âπ «π â) ªìπºŸâªÉ«Ë «â π ßæ À - μ âõ àß È Ë «ß ÿ Àπ àπ μâõß πè ß âπ Õ À Õ «ÀÕ (μ ±å Õß «ßœ) ËßμâÕß ÕÕ πà Õ Ÿ â æ å æ À Õ ªìπºŸâ Ë ªí Ë ßμàÕ ÿπ ß à μ μ Õ à ß â ºŸâªÉ«πÕ â À Õæ μ ÿ æ π Õß æ å ªìπºŸâªÉ«Ë º μ ««π π«à μ ÈÕ â À«æ π åÿ À à π A (H1N1) àß À Ëß π Õ Õ æ π ÿ ÕÁπ Õ Õß ÈÕ ( «RT-PCR ⫺ ªìπ «) «Ë» μ Èß μà «π Ë 1 Õπ π æ.» ß «π Ë 31 Õπ π«æ.» Exclusion criteria ºŸâªÉ«Ë ªìπ â ÀμÿÕ Ëπ Ë à à â À«æ π å À à π A (H1N1) ºŸâªÉ«Ë º μ ««π π«à à âμ ÈÕ â À«æ π å À à π A (H1N1) «Àå âõ Ÿ â «π ß μ à Ë à π âõ À Õ ªÕ å Áπμå SPSS program (version 11.5) º 1. âõ Ÿ Ë«ª ºŸâªÉ«Á Ë Ë ºπ ÿ «πõπæ μ «Ë ßæ À μ Èß μà«π Ë 1 Õπ π æ.».2552 ß «π Ë 31 Õπ π«æ.» â«õ â À«À Õ Influenza-like illness (ILI) Èß Èπ 400 æ ªìπ âà«à à æ π å À à 2009 Ë º μ «π π ªìπ «àßμ «À Ëß Ë Õ ( «RT-PCR) ÈßÀ 107 æ ºŸâªÉ«π«π π Õπ Æ ß Õπμÿ πªï æ.».2552 æ Ÿß ÿ 40 π Õπ ßÀ πªïæ.».2553 Ÿß ÿ 12 π Õπ π π ( Ÿª Ë 1) ºŸâªÉ«ÈßÀ 107 æ ªìπ æ» 44 ( âõ 41.1) æ»à ß 63 ( âõ 58.9) : À ß ªìπ 1:1.4 æ Õ ÿ Ë 7 ªï (μ Èß μà 7 Õπ ß 15 ªï) ª μ «âõ 19.6 (21/107) Ÿª Ë 1 π«πºÿâªé«á âà«à à æ π åÿ À à 2009 π μà Õπ
5 31 ÀÕ À æ Ë ÿ âõ 16.8 (18/107) Õß ß (epilepsy) âõ 1.8 (2/107) æ ª «μ º ºŸâ ªìπ π È âõ 22.4 (24/107) â μâ π «oseltamivir âõ 98.1 (105/ 107) «π Ë Ë â oseltamivir Ë «π Ë 3.8 Õß â (æ μ Èß μà 1 «π ß 7 «π Õß â) (μ ß Ë 1) μà ªìπ«π ˺ŸâªÉ«â πõπ ßæ âõ 95.3 (102/107) Õ Õ ß ß π ºŸâªÉ«Á âà«æ π åÿ À à 2009 Ë» ª «μ æ â âõ 100 (107/107) à«π âõ 72.9 (78/107) «Õß â àõπ ßæ 3-7 «π Õ âõ 97.2 (104/107) πè Ÿ À âõ 36.5 (39/ 107) Á Õ âõ 31.8 (34/107) ÀÕ âõ 11.2 (12/107) μ (μ ß Ë 2) «ÕßÕ ÀÕ Àπ ËÕ àõπ ßæ Ë 1.1«π à«π À à âõ 91.6 (11/12) Ë Õ À ÀÕ Àπ ËÕ àõπ ßæ πâõ «à 2 «π º μ «à ß æ ßªÕ (lung sign) ª μ âõ 61.7 (66/107) æ injected pharynx âõ 28.9 (31/107) æ rhonchi âõ 37.4 (40/ 107) æ crepitation âõ 7.5 (8/107) μ (μ ß Ë 2) «π ËÕ æ ªìπ pneumonia âõ 37.4 (40/107) acute bronchitis âõ 32.7 (35/107) common cold âõ 17.7 μ ß Ë 1 âõ Ÿ Ë«ª ÕߺŸâªÉ«Á Ë ªìπ âà«à à æ π åÿ À à 2009 å âõ Ÿ ß π π«π / π / à«ß Õ ÿ à«ßõ ÿ (range) 7 Õπ ß 15 ªï Õ ÿ Ë 7 ªï æ» : À ß 44 : 63 ª μ «ÀÕ À À Õ ªÕ ÈÕ ß 18 À «À Õ Õ - Ë Àâ Ÿ ÿâ πμë ( Õ Áß Õ Õ Õ ) 1 À«π - μ - 2 À μ ß 0 Á Õ ÿ 15 ªï Ë â Õ æ π ªìπ «π π àπ «Ÿ μõ å - Õâ«π - ª «μ º â ºŸâªÉ«π à π 1-2 μ à âõÿª åªñõß π 24 Ë À (close contact) ºŸâªÉ«Ë â oseltamivir 105 «π Ë Ë â oseltamivir Ë (π «π Ë â) 3.8 «π Õß â «ππõπ π ßæ ( Ë ) 4 «π
6 32 «æ å ªï Ë 36 Ë 1 - π 2554 μ ß Ë 2 Õ ß ß π ÕߺŸâªÉ«Á Ë ªìπ âà«à à æ π å À à 2009 Õ ß ß π π«πºÿâªé«( ) âõ ÕߺŸâªÉ«Õ ª «μ (symptoms) Fever ( â) Cough ( Õ) Coryza ( ªìπÀ«πÈ Ÿ À ) Sore throat ( Á Õ) Headache (ª ) Myalgia (ª«ËÕ â π ÈÕ) Vomiting (Õ π) Dyspnea/tachypnea (ÀÕ ) Diarrhrea (Õÿ à«ß) Õ ß μ «à ß (signs) Lungs sign Rhonchi Crepitation Crepitation + wheezing Wheezing Clear Injected pharynx Seizure Urticaria Ÿª Ë 2 âõ «π ÈÕßμâπ πºÿâªé«á âà«à à æ π åÿ À à 2009 (19/107) acute pharingitis âõ 10.3 (11/ 107) μ ( Ÿª Ë 2) º μ «ßÀâÕßªØ μ ºŸâªÉ«Á âà«à à æ π åÿ À à 2009 Ë» â àßμ «Õ ßÀâÕßªØ μ æ π«π Á Õ «ÈßÀ π Õ WBC (white blood cell count) à«π À àõ Ÿà π à«ß 5,000-10,000 åμàõ Ÿ» å μ âõ 46.7 (50/107) Á Õ «πâõ «à 5,000 åμàõ Ÿ» å μ âõ 42.9 (46/107) æ Á Õ ««à 10,000 åμàõ Ÿ» å μ æ ß âõ 10.3 (11/107) æ âõ Õß Á Õ «π π «øî«å Ë ± âõ Õß Á Õ «π ø μå Ë ± 20.1 (μ ß Ë 3) ºŸâªÉ«Á Ë àßμ «æ ß «ßÕ 104 ÈßÀ 107 æ º μ «ª μ 43
7 33 μ ß Ë 3 º μ «ßÀâÕßªØ μ πºÿâªé«á âà«à à æ π åÿ À à 2009 å º μ «ßÀâÕßªØ μ π«πºÿâªé«( ) âõ ÕߺŸâªÉ«º μ «Õ Ÿ π«π π Õß Á Õ «( ) π«π Á Õ «ÈßÀ ( åμàõ Ÿ» å μ ) < 5, ,000-10, > 10, âõ Õß Á Õ «π π «øî«( à Ë ± SD) ± 21.7 âõ Õß Á Õ «π ø μå ( à Ë ± SD) ± 20.1 æ ß «ßÕ ( ) æ ß «ßÕ ª μ æ ß «ßÕ ªìπ perihilar infiltration æ ß «ßÕ ªìπ patchay infiltration æ ß «ßÕ ªìπ interstitial infiltration æ ß «ßÕ ªìπ ARDS º μ «º ª μ 61 ªìπ perihilar infiltration âõ 45.8 (49/107) ªìπ patchy infiltration âõ 9.3 (10/107) ªìπ interstitial infiltration âõ 0.9 (1/107) ªìπ ARDS (acute respiratory distress syndrome) âõ 0.9 (1/107) (μ ß Ë 3) π π ºŸâªÉ«Á âà«à à æ π åÿ À à2009 âæàπ À Õ 15 â ÕÕ π (oxygen box) 3 2 âõõ π 1-2 «πõ Á Èπ«ÕÕ π saturation â âõ ( Ë ß à â ÕÕ π) æ ß 1 ËÀÕ «ÕÕ π saturation â âõ 92 â â ª ËÀÕºŸâªÉ««ƒμ âõõ π (oxygenbox) 6 «π Õ ß Èπ ºŸâªÉ«âÕ 98.1 (105/107) â μâ π «oseltamivir «π Ë Ë â μâ π «Ë 3.8 «π Õß â â ßÀ ß â μâ π «Ë 2.6 «π ºŸâªÉ«â ªØ «π à«â«âõ 87.8 (94/107) «π πõπ ßæ μ Èß μà 1-9 «π ( Ë 4 «π) ÿ à â à ËÕß à«à æ ß 1 Ë πàõºÿâªé««ƒμ æ ªìπªÕ Õ ÿπ ß ª μ «ªìπ Õ å ÀÕ À ºŸâªÉ«À â π â à ºŸâªÉ««μ μàæ «âõπ â àªõ Õ μ ÈÕ 3 æ Õ À 3 â π ÈÕÀ «Õ à««à ««1 ( àßμ «ª μàõ Ë ß滟π å Õπ àπºÿâªé«õ Èπ â π â) æ «ÁÕ πè 1 ( ËÀâÕß ÿ πæ «π À μμë â Àâ πè ßÀ Õ Õ Õ Èπ «π À μ ªìπª μ ) æ À «μâπ Á«º ª μ π sinus tachycardia 1 ( Ëß ªìπ π π ºŸâ Ë À ««) æ 2 Ëß ª μ «ªìπ â Ÿß (febrile convulsion Õ Ÿà ) «å» π Èæ ºŸâªÉ«Á Ë â π ßæ À μ Èß μà«π Ë1 Õπ π æ.» ß «π Ë 31 Õπ π«æ.» â «π «à ªìπ âà«à à æ π ÿå À à 2009 Èß Èπ 107 ºŸâªÉ«ILI 400 ( âõ
8 34 «æ å ªï Ë 36 Ë 1 - π ) Ëßπà ªìπÕÿ μ å ËπâÕ «à «ªìπ ß π ËÕß ºŸâªÉ«Ë â«õ ILI à â àßμ «À ÈÕ âà«à à æ π åÿ À à ÿ æ «à ªìπ æ» À ß «à æ» (1.4:1) Õ ÿ Ë 7 ªï Ëßμà ß» ÕßÕ «6 Ëßæ æ» «à æ»à ß (1.6:1) Õ ÿ Ëæ àõ 6 Õπ ß 2 ªï ( âõ 41) μà â ß» Õß Koliou M 7 ( Ëßæ ºŸâªÉ«à«π À à Õ ÿ À«à ß 5-10 ªï) æ ª μ «âõ 19.6 à«π À à ªìπ Ÿ æâ ÀÕ À âõ 16.8 Ëß â ß» ÕßÕ «6 Ëßæ ª μ «âõ 17 μà μ μà ß» Õß Seema Jain 8» Õß Rogelio Perez-Padilla 9 Ëßæ ª μ «âõ 7 (198/272) âõ 44.4 (8/18) μ ª «μ º ºŸâμ ÈÕ àõπ ªìπ æ âõ 22.4 (24/107) Ëß μ μà ß» ÕßÕ «6 ( Ëßæ âõ 47) Õ ß ß π æ â Õ πè Ÿ À Á Õ ª ª«ËÕ â π ÈÕ âõ 100 âõ 97.2 âõ 36.5 âõ 31.8 âõ 28 Ëß â Õ Õß âà«à àμ ƒ Ÿ Ëß À Õπ» πμà ߪ» 7,9 Ë «à âõ 95 Õ Õß â Õ à«π À à ( âõ 72.9) â«â ŸßÕàÕπ æ «àõπ ßæ 3-7 «π μà «ÕßÕ ÀÕ Àπ ËÕ àõπ ßæ à«π À à ( âõ 91.6) à π 2 «π Õ π ËÕß Õ ÀÕ Àπ ËÕ ªìπÕ Ë «ÿπ ß À⺟⪠Õß «ß«ß ßæ Á«π» π Èæ ºŸâªÉ«Ë Õ Õß ß π Õ À â àõ π âõß à«â«âõ μ Ëß â ß» Õß Koliou M. 7 6» Õß Õ «º μ «ßÀâÕßªØ μ æ π«π Á Õ «ÈßÀ π Õ à«π À à ( âõ 89.7) ËπâÕ «à 10,000 åμàõ Ÿ» å μ âõ Õß Á Õ «π ø μå Ë ªìπ 34.5± 20.1 Ëß â â μ ÈÕ «æ ß «ßÕ à«π À à âõ 45.8 ªìπ perihilar infiltration Ëß ªìπ æ ß «ßÕ Ëæ â àõ πºÿâªé«ë ªìπªÕ Õ ÈÕ «Ëß â ß» ÕßÕ «6» ÕßSeema Jain 8 æ «à ºŸâªÉ«â μâ π «oseltamivir âõ 98.1 (105/107) â ªØ «π à«â«âõ 87.8 (94/107) ÿ Àâ ºŸâªÉ«π «π Ë Ë Àâ oseltamivir Ë «π Ë 3.8 Õß â Ëß â «à Ë «ß ÿ Àπ Õ π 48 Ë«ßÀ ß â Õ ªìπ æ ºŸâªÉ«à«π À à ( âõ 72.9) à â æ æ å Ë ßæ π π Ë â 1-2 «π μà ßæ À ß Õ ŸÕ â«à Èπ μà â ß º» Õß Seema Jain 8 6 Õ «Ë Ë Àâ oseltamivir Ë «π Ë 3 4 «π Õß â º» àæ ºŸâªÉ«Á «μ Ëßμà ß º» Õ ËπÊ πμà ߪ» 6,8-10 Ëæ «μ âõ 39 (7/18) âõ 7 (19/272) âõ 5 (13/ 251) âõ 4.6 (3/65) μ «âõπ Ëæ àõ ªìπ Àμÿ «μ» Õ ËπÊ 8-12 æ ªÕ Õ ÿπ ß (severe pneumonia) À â À ««æ àõß ÕÕ π (refractory hypoxemia, respiratory failure) À Õ ÿà Õ ß πà æ π (acute respiratory distress syndrome) μà» π È æ «âõπ â à ªÕ Õ μ ÈÕ 3 â π ÈÕÀ «Õ 1 Õ À 3 ( Ëßæ â π â «ß Ë) μà àæ ºŸâªÉ««μ ªìπ ª â ˺ŸâªÉ«ËßÕ ÿπ ß à æ à Ë ß ΩÑ «ß Ë ª æ «Èß ªØ μ μ π«ß Ë «ß ÿ Àπ «â àߺ Àâ «âõπ Õ μ «μ ß â ÿª» π Èæ ºŸâªÉ«Á μ ÈÕ âà«à à
9 35 æ π åÿ À à 2009 à«π À à Õ Õ ß ß π â μ ÈÕ âà«à à μ ƒ Ÿ ª ËßÀπ Ëßæ æ ß «ßÕ Ë ªÕ Õ ºŸâªÉ«à«π À à Õ à ÿπ ß â μâ π «oseltamivir Õ ÈßÀ ( μà â â «à Ë «ß ÿ Àπ ) μ π«ß Õß «ß ÿ πà ªìπ Àμÿ À⺠μμ ª» Õ Õ ÿ π æ å ÿπ πμåμ Ÿ ºŸâÕ π«ßæ À Ë π πÿπ Õπÿ μ Àâπ πõº» π È Õ Õ ÿ ÿ æ å ÿ à π â Àπâ Ë ÿà ß π «ß μ Õ π â Àπâ Ë ßæ À ÿ à π ËÕ π«««π ««âπà âõ Ÿ Ë â π» Èßπ È Õ Õâ ßÕ ß 1.»Ÿπ å âõ Ÿ «ß ÿ ªÑÕß π «ÿ â π å Õß âà«à à «ß ÿ 2552 «π Ë , ß π â π æ «ß ÿ à«æ å» μ å Õß À «μà ßÊ. Clinical practice guideline π«ßªø μ Ÿ ºŸâªÉ«Ëμ ÈÕÀ ÕÕ μ ÈÕ âà«à à æ π åÿ À à π A (H1N1). æ æå Èß Ë 1. ÿß æ À π : «ß ÿ ; ß π â π æ æ å «ß ÿ æ å» μ å» æ ßæ ßæ ÿã ß å. π«ßªø μ Ÿ ºŸâªÉ«Ëμ ÈÕ À ÕÕ μ ÈÕ âà«à à æ π åÿ À à π A (H1N1). æ æå Èß Ë 2. ÿß æ À π : «ß ÿ ; ß π â π æ æ å «ß ÿ, æ» π «π, ÿ æ Ÿ å, Õ», πõ» Ï Õ π π ππ å, ÿæ π å. π«ß ªØ μ Ÿ ºŸâªÉ«Ëμ ÈÕÀ ÕÕ μ ÈÕ âà«à à æ π åÿ À à π A (H1N1). æ æå Èß Ë 2. ÿß æ À π : «ß ÿ ; π«π å ª æ. Management of pediatric pneumonia in H1N1 influenza pandemic Õ ª Õ ª ÿ ß à Õ π«ß π πß π À æ å π àß ß π â ß Ÿ ÿâ π ªÑÕß π μ ÈÕ æ π À π Á μë «à 6 ªï μ μàõ ß Õ À πè æƒ 2553; ß π å Õπ «π Ëπ. ÿß æ À π ; Õ «æß»å. Õ ß π ÕߺŸâªÉ«Á âà«à à æ π å À à Ë â Ë ßæ À π». ««μ ;20: Koliou M, Soteriades ES, Toumasi MM, Demosthenous A, Hadjidemetriou A. Epidemiological and clinical characteristics of influenza A (H1N1) infection in children : The first 45 cases in Cyprus, June-August Euro Surveill 2009;14: Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, et al. Hospitalized patients with 2009 H1N1 influenza in the United States, April-June N Engl J Med 2009;361: Perez-Padilla R, de la Rosa-Zamboni D, Ponce de leon S, Hernandez M, Quinones-Falconi F, Bautista E, et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med 2009;361: Libster R, Bugna J, Coviello S, Hijano DR, Dunaiewsky M, Reynoson N, et al. Pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1) in Argentina. N Engl J Med 2010;362: Kumar A, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J, et al. Critically ill patients with 2009 influenza A (H1N1) Infection in Canada. JAMA 2009;302: Louie JK, Acosta M, Winter K, Jean C, Gavali S, Schechter R, et al. Factors associated with death or hospitalization due to pandemic 2009 influenza A (H1N1) infection in California. JAMA 2009;302:
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