目的：了解近年儿童麻疹新出现的流行病学趋势、临床特征及治疗。方法选取2010年1月—2013年12月河南中医学院第一附属医院和河南省周口市中心医院传染科收治的麻疹患儿110例，回顾性分析麻疹患儿的年龄分布、地区分布、疫苗接种情况及麻疹接触史、临床表现、并发症及治疗与转归，分析目前儿童麻疹的发病特点及诊治情况。结果110例麻疹患儿中40例（36.4％）未曾明确接种过麻疹疫苗，68例（61.8％）接种疫苗1次，2例（1.8％）接种疫苗2次。8月龄以下者28例，其中母亲接种过疫苗且未感染过麻疹22例。临床表现以发热、皮疹、畏光流泪、口腔黏膜粗糙及Koplik斑为主，25例（22.7％）出现了类百日咳样咳嗽。并发症以支气管肺炎（45.5％，50／110）、心肌损害（40.9％，45／110）、支气管炎（30.0％，33／110）居多，4例（3.6％）患儿出现闭塞性细支气管炎。72例（65.5％）使用抗生素，前3位为头孢呋辛钠注射液、头孢曲松钠注射液及头孢派酮－舒巴坦钠注射液；34例（30.9％）使用抗病毒药物利巴韦林；29例（26.4％）使用丙种球蛋白注射液；103例（93.6％）使用中药制剂，前3位为热毒宁注射液、穿心莲内酯注射液、痰热清注射液。临床痊愈出院85例（77.3％）、好转出院23例（20.9％）、死亡2例（1.8％），死亡原因为麻疹并发重症肺炎、呼吸衰竭及心力衰竭。结论8月龄以下婴儿及单次接种疫苗儿童成为麻疹的新兴高发人群，临床表现仍以典型症状为主，但需注意类百日咳样咳嗽的出现，抗生素治疗在麻疹合并肺部感染中较为广泛，中成药以清热解毒药物居多。%Objective To investigate the epidemiological trend, clinical features and treatment of childhood measles.Methods Enrolled 110 measles children who were admitted by the Department of Infectious Disease of the First Affiliated Hospital of Henan University of TCM and Zhoukou Central Hospital of Henan Province from January 2010 to December 2013.A retrospective analysis was made on age distribution, regional distribution, vaccination, the history of contact with measles patients, clinical manifestation, complications, treatment and relapse.The clinical characters and diagnosis of childhood measles were analyzed.Results In all 110 cases, 40 children ( 36.4%) had not been vaccinated definitely, there were 68 (61.8%) children had vaccination once, 2 (1.8%) children had vaccination twice.28 children were younger than 8 months among which 22 children′s mother had got vaccinated and never been infected.Main clinical manifestations were still fever, rash, photophobia, tears, rough oral mucosa and Koplik′s spots, and pertussis -like symptom occurred in 25 ( 22.7%) patients.Complications were mostly bronchopneumonia (45.5%, 50/110), cardiac damage (40.9%, 45/110) and bronchitis (30.0%, 33/110), and obliterative bronchiolitis occurred in 4 (3.6%) patients.There were 72 (65.5%) patients who had used antibiotics, and the three mostly used antibiotics were cefuroxime sodium for injection, ceftriaxone sodium for injection and cefoperazone and sulbactam sodium for injection; 34 ( 30.9%) patients had used ribavirin; 29 ( 26.4%) had used gamma globulin injection; 103 patients (93.6%) had used patent herbal medicine injection, and the three mostly used were Reduning injection, Andrographolide injection and Tanreqing injection.There were 85 (77.3%) patients who were cured and discharged from hospital, 23 (20.9%) patients who had improvement and discharged from hospital and 2 (1.8%) patients who died.The causes of death were measles complicated with severe pneumonia, respiratory failure and cardiac failure.Conclusion Infants younger than 8 months and children who get a single vaccination are newly found group that had high-risk for measles, and clinical manifestations are still mainly typical symptoms, while it should be noted that pertussis-like symptoms should be paid more attention.Antibiotic therapy has extensive application in the treatment of measles combined with pulmonary infection, and the most applied Chinese patent medicine is heat-clearing and detoxifying drugs.
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