“医生，我们家孩子上周五就开始出现发热，自测甲流抗原阳性，口服奥司他韦5天了，吃了药，体温稳定了2天，但昨晚又体温升到了38℃以上，又有些咳嗽了。”1月3日上午，在上海交通大学医学院附属新华医院儿童感染科门诊，一名家长带着2岁大的女儿乔乔来就诊。
当下，正处于呼吸道传染病的高发季节。“上海疾控”官方微信号2024年12月31日发布消息：近期，上海市疾控中心呼吸道传染病监测结果显示，目前上海市流感病毒活动强度明显增强，已进入高发期，但流行强度处于历年一般水平。
上海交通大学医学院附属新华医院儿童感染科主任焦先婷表示，大约2周前，儿科门急诊患儿数量显著增加。但与2023年支原体肺炎感染高峰期时的工作强度相比，今年还是好了很多。“目前，我们儿科医生还能应付得过来，周末两天门诊也都开放，病床也没有上一年秋冬季那么紧张了，因为各种病原体感染需要被收治住院的患儿总体也不算多，大约占10%，但是流感并发症还是比较凶险，最近我们也收治了几例危重患儿。”
焦先婷透露，目前来她这里诊疗的急性感染患儿中，流感患儿占比近一半，其次有腺病毒、人偏肺病毒、支原体等，而支原体肺炎患儿明显较上一年同期出现了大幅度的下降。
“根据往年的经验来判断，我们儿童的感染高峰往往是随着期末考试的结束而结束，感染的几率就会有所减少。”焦先婷说。
1月3日上午，上海交通大学医学院附属新华医院儿童感染科门诊，医生焦先婷查看一名发烧咳嗽患儿的肺部影像图。本文图均为澎湃新闻记者 陈斯斯 摄
2-10岁患儿就诊人群多，流感进入高发季
1月3日上午，在焦先婷的门诊中，2-10岁患儿几乎占据了90%。“白天来的主要是幼儿园、小学阶段的孩子，而到了晚上和周末，不少初高中生来看病。”
焦先婷为患儿看诊。
当前，在焦先婷这里诊疗的急性感染患儿中，流感患儿占比将近一半，其次有腺病毒、人偏肺病毒、支原体等等，而支原体肺炎患儿明显较上一年同期出现了大幅度的下降。
“目前这几个常见的病原学是可以通过快速抗原或核酸检测出来的，好在流感病毒目前是有特效药物的，而腺病毒、人偏肺病毒或者呼吸道合胞病毒是没有针对该病毒的药物，这也是家长不放心，在患儿发热期间反复来医院的一个原因。”焦先婷解释说。
根据2024年12月底中国疾控中心发布的监测数据显示，近期14岁及以下病例中，人偏肺病毒阳性率呈波动上升趋势。
焦先婷进一步表示，在过去，人偏肺病毒的大众知晓度并不高，其实这种病毒一直存在，它和流感病毒一样，是一种会引发急性呼吸道感染的常见病毒，主要症状有发烧、咳嗽、流鼻涕，也并不是一种新的病毒，引起重症的可能性不大，大家不必过度担心。注意勤洗手、戴口罩、避开人群聚集或者空间密闭的场所，可以起到有效预防效果
在就诊人群中，不少是家里父母、老人等家庭成员都出现发烧、咽痛、流涕、咳嗽等流感样症状的，有一些患儿已在家门口的医院做了检测，或配了药，但仍然高烧不退，因此又来了这里看专家。
7岁患儿颖颖就是其中一例。家里父母连续出现了发烧、咽痛的症状，大人吃了点感冒药，一周左右都扛过去了，颖颖又开始发烧，在家下单了外卖平台的居家快检服务，上门一检测，测出来得了甲流，颖颖的父母赶紧带颖颖来医院。
焦先婷表示，当前，在她门诊中，检测出流感患儿几乎占据了近一半，大部分是甲流，主要症状就是发烧、咳嗽、咽痛、头晕等，有些甚至也没有流鼻涕的症状。“这时候，我们就会给家长建议，针对流感病毒，临床上是有特效药的，吃奥司他韦满5天，或者孩子满5岁了，也可以吃一粒‘速福达’（玛巴洛沙韦）来进行治疗，如果出现发烧症状的话，再服用一些美林、泰诺林等退烧药缓解一下发热症状就可以。”
焦先婷表示，针对流感特效药，往往是越早服用越好，这样治疗的效果也会更好，疾病进展也更早地能够控制住。
而对于流感疫苗，焦先婷也建议最好能提前接种，可以起到比较好的预防效果，“目前新华医院疫苗门诊还有鼻喷流感疫苗，效果也很好”。
反复感染患儿占据不少，混合感染是一大原因
焦先婷也提到，当前，出现呼吸道反复感染的人群也不在少数。
“反复感染可能是混合感染，上一次感染还没完全恢复，吃了点药，烧退了，但还没有完全恢复，免疫力还是比较弱，这时候如果立即返校或前往人员密集的封闭空间，就可能有再次感染其他病原体的风险。”焦先婷说，一般情况下，我们会建议孩子身体恢复后，能休息一周时间，等身体彻底恢复后再去返校，这样对孩子增加身体免疫力、减少再次呼吸道病原体的感染几率更有益处。
焦先婷为患儿家长开展用药指导。
2岁患儿佳佳，就诊时已发烧4天，伴有咳嗽，一度最高发烧到39.5℃，家长立马带她到家附近的二级医院就诊，一查是甲流，就开始口服奥司他韦治疗，发烧控制住了。但在一周前，孩子又患上了水痘，躯干和面部清晰可见散发的皮疹，而在1月2日晚，孩子又出现了发烧、腹泻，家长特别带孩子赶来新华医院看专家。
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家长问医生：“发烧整整一周了，之前还去挂了抗生素治疗，但仍然没‘压’下去，这究竟是怎么回事？”
焦先婷解释说：“这种情况的原因，可能孩子是感染了疱疹病毒，病毒感染在引起发热的同时，对口腔黏膜造成了 一定程度的损伤引起了口腔溃疡，口周疱疹，这种情况一般发热的时间就会比较久一点，需要特别注意，另外，抗生素的使用也是一个需要引起重视的问题，在不明确病因的情况下就滥用抗生素，不仅不能起到良好的治疗效果，还可能引发抗生素耐药，影响后续治疗，也不利于孩子免疫力的恢复。
上述专家同时提醒，在临床中，她也遇到过一些家长给孩子用药的误区，有些家长一看到孩子发烧、感冒了就惊慌失措，拿起家里的抗生素就给患儿服用误以为能退烧，事实上，发热、咳嗽等疾病初期，以病毒感染占了很大比例，不主张使用抗生素。“抗生素只针对细菌和一些支原体等有效，乱用抗生素不仅不会缩短疾病的病程，反而可能会产生一些副作用，比如药物过敏、耐药、肝肾受损等等。”
还有一些家长一到医院就强烈要求使用静脉输注消炎药，焦先婷认为这也是不可取的。“治疗上应遵从医生的医嘱，而不是所认为的静脉输消炎药就是好的快。”
焦先婷强调，针对流感特效药奥司他韦和速福达的使用，5岁以上患儿还是建议服用速福达，奥司他韦的疗程是吃满5天，才能起到真正的效果。
而针对退烧药的使用，焦先婷同时指出，退烧药的使用间隔时间和使用次数要特别注意，拿泰诺林（对乙酰氨基酚）来说，使用间隔大于6小时，24小时使用次数≤4次。而美林（布洛芬）使用间隔大于6小时，24小时使用次数≤4次。在高热持续不退的时候，这两种药物可以交替使用，最短间隔在4小时以上，一天24小时一个退烧药使用总次数不超过4次。
另外，焦先婷也表示：“需要注意的是，无论是在学校还是在家里，每天都要注意保持一定时间的通风，保持室内空气的流通，降低呼吸道病原体的传播，同时也建议这期间孩子尽量不要前往公共场所、人员密集处，或者做好防护，戴好口罩、勤洗手，尽可能避免交叉感染。”
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