妊娠合并重症新型甲型H1N1流感13例临床分析

Clinical analysis of severe novel influenza A(H1N1) virus infection in pregnant women:a report of 13 cases

目的探讨妊娠合并重症新型甲型H1N1流感的临床及治疗特点。方法对2009年11月7日至12月18日中国医科大学附属盛京医院收治的妊娠合并重症新型甲型H1N1流感住院的13例患者临床资料进行回顾性分析。结果13例患者均为妊娠中晚期,均伴有发热、气短症状。11例有低蛋白血症,6例脑钠肽增高,7例D-二聚体增高,10例氧合指数小于300。7例入住重症监护病房(ICU),2例死亡。8例行紧急剖宫产手术,其中4例新生儿存活,3例胎死宫内,1例新生儿死亡。入住ICU的患者平均孕龄为31.7周,而非入住ICU的患者平均孕龄为21.7周,两组差异有统计学意义(P<0.01)。结论妊娠妇女是重症新型甲型H1N1流感的高危人群;孕龄与病情严重程度相关;适时中止妊娠、抗凝及负液平衡治疗对预后至关重要。

Objective To analyze the clinical data of 13 pregnant patients with severe novel influenza A （HINI） virus infection. Methods The clinical data of 13 pregnant inpatients with severe novel influenza A （HI N1 ） virus infection,who were treated in our hospital from Nov. 7,2009 to Dec. 8,2009, were retrospectively analyzed. Results The 13 patients were pregnant in second or third trimesters. All patients had fever and shorthess of breath, 11 had hypoalbuminemia,6 had elevated cardionatrin,7 had elevated dipolymer,and 10 had oxygenation index lower than 300. Seven patients were admitted to the intensive care unit（ICU） and 2 died. Eight patients received emergent cesarean,and 4 neonates survived,3 fetuses died in uterus and 1 neonate died. The median gestational age of patients, who were admitted to ICU, was 31.7 weeks, while that of patients not admitted to ICU were 21.7 weeks,with the difference of gestational ages between the 2 group being significant（ P 〈 0.01 ）. Conclusion Pregnant women are at higher risk of severe novel influenza A （ H1N1 ） virus infection. The gestational age is associated with the severity of the diseases. Ceasing pregnancy with timely cesarean, anticoagulation and negative fluid balance treatment are crucial to the prognoses of patients.