重症甲型H1N1流感病毒肺炎的临床和病理特征

Clinical and Pathological Features of Severe Influenza A H1N1 Influenza Virus Pneumonia

目的:探讨危重症甲型H1N1流感病毒(甲流)肺炎患者的主要临床特点,分析其气道内分泌物及肺、心脏病理学改变与持续性低氧血症的关系。方法:回顾性分析入住呼吸重症监护病房(RICU)的24例危、重症甲流肺炎患者的临床资料。24例均用抗病毒治疗(达菲剂量75或150mg)每日2次,24例中20例用激素治疗,6例行气管插管机械通气治疗。结果:24例患者平均年龄(48.25±19.73)岁,孕产妇、肥胖及有慢性基础病者15例。进行性气短、咳嗽、肌肉酸痛是主要症状。双肺多发实变影22例(91.67%)。入院后5例气道内分泌物中蛋白质为34.1～37.7g/L,乳酸脱氢酶(LDH)为792～1890U/L。白细胞计数为(0.722～1.470)×109/L,中性粒细胞0.21～0.44,单核细胞为0.111～0.560,嗜酸粒细胞为0.027～0.110,嗜碱粒细胞为0.018～0.054。病理学变化有肺透明膜形成、肺泡腔塌陷、心肌细胞变性和心肌灶性坏死。气管插管机械通气支持治疗6例,死亡5例,病死率20.83%。结论:气道内分泌物LDH、蛋白质升高、炎性细胞增多是危重症甲流肺炎患者肺部病理损害的表现;机械通气支持治疗对于肺内广泛实变者效果不理想,且相关的并发症是部分患者病情加重或死亡的促发因素。

Objective：To investigate the main clinical features of critically ill patients with influenza A （H1N1） influenza virus pneumonia,and the relationship between airway secretions and cardiopulmonary pathology change with continuous hypoxemia. Methods：The retrospective analysis was made in critically ill patients with H1N1 influenza virus pneumonia admitted to a respiratory intensive care unit（RICU）. Twenty-four patients were all administrated antiviral drugs （oseltamivir 75/150 mg Bid）. Twenty of them were subjected to application of hormonal therapy,and 6 of them with mechanical ventilation. Results：The average age of 24 patients was （48.25±19.73） years old. Fifteen of them were pregnant women,obesity and who suffered from chronic underlying diseases. The main symptoms of them were progressive shortness of breath,cough and myalgia. It was found by X-ray that 22 patients （91.67%） had multiple lung consolidation shadow. After admission,airway secretions were collected,and the protein concentration of which was 34.1-37.7 g/L in 5 cases. The concentration of l-lactate dehydrogenase（LDH） was 792-1 890 U/L. White blood cell count was （0.722-1.470）×10^9/L,included 0.21-0.44 neutrophils,0.111-0.560 mononuclear cells,0.027-0.110 eosinophils,0.018-0.054 basophils. Pathological changes of these patients were hyaline membrane formation,alveolar cavity collapse,myocardial cell degeneration and focal myocardial necrosis. Intubation and mechanical ventilation were performed in 6 cases,5 of them dead and the mortality rate was 20.83%. Conclusion：The lung pathological damages were increased LDH and protein in airway secretions,and increased count of inflammatory cells. Effect of mechanical ventilation was not satisfied in part of patients who had diffuse lung consolidation in X-ray,and the related complications leaded to exacerbation or death in part of them.