新型甲型H1N1流感重症和危重病例75例临床分析

Clinical analysis of 75 severe and critical patients with novel influenza A(H1N1)

目的分析新型甲型H1N1流感重症和危重病例的临床特点,并对其诊治方法进行探讨。方法对2009年10月24日至12月12日中国医科大学附属第一医院收治的75例新型甲型H1N1流感重症和危重病例的临床症状、实验室检查及影像学资料进行回顾性分析。结果75例患者中男54例,女21例。年龄18～66岁,平均42.4岁。重症患者29例,危重症患者46例。16例患者有明确的接触史,平均潜伏期3.5d;56.0%的患者以发热为首发症状,10.7%的患者病程中没有出现发热,20.0%的患者出现血性痰;90.7%的患者肺部可闻及啰音笛槭壹觳?78.7%的患者中性粒细胞比率升高,74.7%的患者淋巴细胞比率降低;56.7%的患者白蛋白降低,乳酸脱氢酶(LDH)明显升高(58.2%);外周血T细胞亚群CD4明显降低(57.1%)。肺CT主要表现为双肺多发的斑片影和磨玻璃影。出现急性呼吸窘迫综合征(ARDS)23例,其中10例死亡。结论新型甲型H1N1流感诊治的关键是早期识别重症和危重病例,并及时给予奥司他韦治疗,综合支持治疗可取得较好的疗效。

Objective To analyze the clinical features of patients with severe and critical influenza A （H1 N1 ） ,and to discuss the methods for its diagnosis and treatment. Methods The clinical features,laboratory findings, and the image data of 75 influenza A（ H1N1 ） patients, who were admitted to the First Affiliated Hospital of China Medical University during October 24,2009- December 12,2009 ,were retrospectively analyzed. Results The patients included 29 severe cases and 46 critical cases,54 males and 21 females, with an age range of 18 66 years and a mean of 42.4 years old. Sixteen patients had definite contact history ; the mean latency was 3.5 days. The most common initial symptoms included fever（56.0% ） , bloody sputum（20. 0% ） and rales（90. 7% ）. Blood routine showed that 78.7% of patients had increased GRAN, 74.7% had increased lymphocyte ratio, 56. 7% had hypoalbuminemia ,58. 2% had increased LDH. Analysis of peripheral T lymphocyte subgroup showed that 57. 1% patients had decreased CD4. However, 10. 7% patients had no fever in the course of disease. The major findings of lung CT were multiple ,bilateral patchy opacity and ground glass opacity. The major findings of pulmonary function test were restrictive ventilatory functional disturbance and severe diffusion dysfunction. Twentythree cases had ARDS （ 10 death cases all had both ARDS and MODS）. Conclusion Early identification of severe and critical influenza A （H1 N1 ）patients and early treatment with oseltamivir are the keys for diagnosis and treatment;and comprehensive therapy and supporting therapy can achieve better therapeutic effects.