95例甲型H1N1流感患者危险因子及临床治疗分析

Analysis on risk factor and clinical therapy of 95 patients with A （H1N1） influenza

目的通过对确诊甲型H1N1流感成人患者救治手段，主要是药物治疗的综合分析，以探讨针对不同病情的甲型H1N1流感患者抗病毒药的临床应用和疗效以及合理的治疗方案。方法收集2009年6月至2010年2月在我院确诊并治疗的甲型H1N1流感成人患者共95例，采用回顾性研究的方法，根据病情分3组：轻症、重症和危重症，分别对各组患者健康情况、住院天数、最高体温、发热持续时间、奥司他韦服用情况及开始时间、联合其他抗病毒药情况及综合支持治疗等进行综合分析。结果有重症化危险因素的人数在3组病例中所占比率分别为5．3％、18．2％、66．7％，两两比较差异均有统计学意义（P〈0．05）。持续发热的平均时间3组病例分别为2．2、5．6和9．4d（P〈0．01）。开始口服奥司他韦平均时间危重组明显晚于其他两组（P〈0．01）；口服奥司他韦疗程分别为（4．1±0．4）d、（6．3±0．5）d和（9．2±1．8）d（P〈0．05）；常规剂量奥司他韦不良反应极少。危重组患者的病毒清除时间明显延长。呼吸机辅助呼吸、抗生素应用、皮质类固醇激素应用、血浆支持等综合治疗对重症患者是必要的。结论存在危重高危因素，尤其是有呼吸道及内分泌（特别是糖尿病）等基础疾病的患者更易重症化。发热时间越长，重症化倾向也越大。奥司他韦是安全有效的，但需尽早应用；重症患者，尤其是有呼吸道基础疾病的需延长疗效。对重症及危重患者的综合支持治疗至关重要。

Objective To explore the curative effect of antivirus drugs to the patients with different degree A（H1N1） influenza, and to summarize the reasonable treatment protocols. Methods The clinical data of 95 adult patients with A（H1N1） influenza from June 2009 to February 2010 were collected and analyzed retrospectively. The differences in mild, severe and critical patients in physical status, hospital days, temperature peak, persistent fever period, osehamivir treatment, other antiviral drugs and combined therapy were compared. Results There were statistical differences in risk factor （5.3%, 18.2% ,66.7%, P 〈 0.05）, persistent fever period （2.2 days,5.6 days, 9.4 days, P 〈 0.01 ）, courses of treatment of oseltamivir were （4.1 ± 0.4 ） days, （6.3 ± 0.5 ） days, （9.2 ± 1.8） days respectively （P 〈 0.05）. There were statistical differences among critical patients and mild, severe patients in mean onset days of oseltamivir oral（ P 〈 0.01）. Cleaning time of virus in critical cases was longer than others cases. Comprehensive therapy included mechanical ventilation, antibiotics, corticosteroid and blood plasma was necessary in severe patients. Conclusions The patients with critical high risks, especially with respiratory diseases or endocrine diseases, would progress to severe condition. The longer the fever, the easier to progress to severe condition. Oseltamivir is safe and effective, it is important to use it as early as possible. Oseltamivir should be used longer on the patients with severe condition, especially with respiratory disease. The comprehensive therapy is extremely important to severe patients.