新型甲型H1N1流感重症17例临床特征分析

Study of symptom of 17 severe patients with new-type influenza A(H1N1)

目的探讨新型甲型H1N1流感重症的流行病学特征、临床发病特点及治疗方法。方法对2009年10月至2009年11月北京佑安医院收治确诊的17例甲流患者的流行病学,临床特征和治疗转归进行回顾性分析并总结。结果17例患者既往没有流感疫苗接种史,有流感患者接触史者有4例,占23.5%,既往健康者有14例,占82.35%。甲型H1N1流感重症年龄多发生于2岁到12岁少年儿童,占本组病例64.71%。临床症状高热有16例,占94.11%,首发症状高热为主体温39℃以上10例,占本组病例58.82%,其中高热和咳嗽同时出现5例(29.4%),其次咳嗽有7例(49.4%)。合并症主要是肺炎,有15例(88.2%),多脏器功能不全4例(23.5%),有基础性疾病4例(23.5%)。动态血生化检测及其他检查中肝功能异常者9例(52.9%),心肌酶谱异常者7例(41.2%),心电图异常者9例(52.9%)。在出现症状到病毒阴转时间上,多数在2到7天,平均(4.2±1.67)天;在给予治疗到病毒阴转时间上,多数在1到4天,平均(1.88±1.78)天。治疗方面使用中药加奥司他韦7例(49.4%),中药治疗5例(29.4%),未用中药或奥司他韦3例,奥司他韦治疗2例(11.8%)。治疗痊愈出院16例(94.1%),死亡1例。结论新型甲型H1N1流感危重症发病年龄少年儿童多见,首发症状高热、咳嗽,肺炎是主要合并症。及时给予治疗,绝大多数均能获得痊愈,预后良好。

Objective To study new-type influenza A （ H1 N1 ） patients＇ epidemiology, symptom and therapy. Methods To retrospectively study epidemiology, symptom and therapy of 17 severe cases with the disease in Beijing Youan Hospital from October to November 2009. Results All the cases had not had the vaccination. And among them, 4 cases （23.5%） contacted the patients with the disease, 14 cases （ 82.35% ） were healthy before. Majority of the cases（ 10 cases,58.82% ） were 2 - 10 years old. 10 cases （58.82%） first had high fever above 39℃ , among them 5 cases（29.4% ） had cough synchronously, 7 cases （49.4%） had cough subsequently. The syndromes were pneumonia （15cases, 88.2% ） , MODS （4 cases, 23.5% ） , and other basic diseases （4 cases, 23.5% ）. As for biochemistry test and others, 4 cases （23.5%） were deviant in liver function, 7 cases （41.2%） deviant in cardiac muscle enzymes, 9 cases （52.9%） deviant in EKG. Among majority of the cases, the virus mark became negative after 2 -7 days [ mean ： （4.2 ± 1.67） days ] since the prodromal period, and after 1 - 4 days [ mean ： （ 1.88 ± 1.78） days] after treatment. Among them, 7 cases （49.4%） were treated with Chinese traditional medicine and tamifluy, 5 cases （29.4%） only with Chinese traditional medicine., 2 cases （11.8%） only tamifluy, and 3 cases （17.6%） with not Chinese traditional medicine or tamifluy. 16 cases （94.1%） left hospital after healing. Conclusions The severe cases, whose first symptoms was high fever and cough, and whose syndrome was pneumonia, came on mostly in infants. Majority of the cases could be healed with treatment.