24例甲型H1N1流感并发重症肺炎患者的临床分析

Clinical analysis of 24 cases of influenza A H1N1 complicated with severe pneumonia

目的:探讨新型病原体甲型H1N1流感病毒所致危重患者的临床特征,为判断病情和治疗提供参考。方法:对24例甲型H1N1流感并发重症肺炎患者的一般临床资料、症状、体征、辅助检查、诊断及治疗方法和结果进行分析。结果:24例患者平均年龄(28.73±9.24)岁,其中孕妇2例(8.3%),肥胖[体质指数(BMI)≥30]18例(75%),有慢性基础疾病者2例(8.3%),包括支气管哮喘1例,肾移植术后1例。患者以发热、咽痛、气短为主要症状。双肺多发实变20例(83.3%)。24例患者均给予抗病毒治疗(奥司他韦75mg或150mg每日2次口服),其中22例(91.6%)患者应用激素治疗,18例(75.0%)患者采用机械通气治疗,6例(25.0%)患者经气管插管行机械通气治疗,2例(8.3%)患者死亡。结论:甲型H1N1流感并发重症肺炎患者以青壮年为主,孕妇、肥胖、有慢性基础疾病者感染后易并发重症肺炎,应尽早应用抗病毒药物、合理应用糖皮质激素和人工通气辅助治疗,张力性气胸、多脏器功能不全等相关并发症是其主要死亡原因。

Objective To study the chinical characteritics of critical patients cased by influenza A H1N1 virus,a new pathogen,in order to provide references for diagnosis and treatment.Methods The general clinical data,symptoms,signs,laboratory examinations,diagnosis and treatment methods and results in 24 cases of influenza A H1N1 complicated with severe pneumonia were analyzed.Results The mean age of 24 patients was（28.73±9.24） years,in which 2 cases of pregnant women（8.3%）,obesity（body mass index（BMI） ≥ 30） 18 cases（75.0%）,chronic underlying diseases 2 cases（8.3 %）,including 1 case of bronchial asthma,1 case of post renal transplantation.Fever,sore throat,shortness of breath were the main symptoms of patients.Multiple lung consolidation was found in 22 cases（91.6%）.24 patients were treated with anti-viral therapy（oseltamivir 75 or 150 mg,oral administration,2 times per day）,20 cases with hormone therapy（83.3%）,18 patients were treated with mechanical ventilation（75.0%）,of which 6 cases with mechanical ventilation after endotracheal intubation（25.0%）,2 death（8.3%）.Conclusion Influenza A H1N1 complicated with severe pneumonia mainly occurs in young adults;the pregnant women,obesity,patients with chronic underlying diseases are easily complicated with severe pneumonia after infection;the antiviral drugs,glucocorticoids adjuvant therapy and artificial ventilation should be used as soon as possible.Tension pneumothorax,multiple organ dysfunction and other related complications are the main causes of death.