危重型孕产妇甲型H1N1流感临床探讨(附8例报告)

Clinical reseach of the gravida with critical A H1N1 influenza(report of 8 cases)

目的探讨危重型孕产妇甲型H1N1流感的流行病学及临床特征,为该病的防治、诊断和治疗提供理论依据。方法对本院收治的8例危重型孕产妇甲型H1N1流感病例的相关资料进行回顾性分析。结果 5例发病前7 d内有发热流感样患者密切接触史。年龄19～23岁,平均21.17岁。中孕2例,晚孕6例。病情危重期出现在病程第3～5天。临床表现以急性呼吸窘迫综合征为主的多器官功能障碍。入院时白细胞总数平均值为8.69×109/L,中性粒细胞比例为83.1%,淋巴细胞为8.82%。7例胸部X线片均表现为两肺广泛大片状密度增高阴影。治疗上采取了以抗流感病毒、机械通气及免疫球蛋白应用为主的综合性措施。治愈6例,死亡2例。6例治愈患者平均住院时间为19.17 d,平均治疗费用6.35万元。结论危重型孕产妇甲型H1N1流感是一种新发的致命性传染病,以中、晚期孕妇为主,病情进展迅速,临床表现为病毒性肺炎和急性呼吸窘迫综合征。早期抗病毒治疗、积极产科处理、实施免疫封闭和适时机械通气是降低病死率的关键环节。

Objective To explore the epidemiological and clinical characteristics of the gravida with critical AH1N1 influenza and provide the theoretical evidences for its prevention,control,diagnosis and treatment.MethodsThe data of 8 gravidas with critical AH1N1 influenza in our hospital from December 2009 to January 2010 were analyzed retrospectively.ResultsFive cases had a history of direct contact with influenza cases.They were 19-23 years old,average 21.17 years old.Medium-term gestational period 2 cases,late gestational period 6 cases.The period of apparent manifestation occurred on the 3rd-5th day.Main clinical characteristics of these cases were multiple organ dysfunction syndrome（MODS）,acute respiratory distress syndrome（ARDS） was the most herniated.On admission total white blood cells were medially 8.69×10^9/L,N 83.1%,L 8.82%.Seven cases had widespread density-heightening shadow in double lungs of all remedies,antiviral therapy,mechanical ventilation therapy and using IG were the most important.Six cases were cured,2 cases died.Mean LOS of the cases cured was 19.17 days and the fee was 63 500 yuan. ConclusionCritical AH1N1 influenza in the gravidas is a new and fatal infectious disease.Most cases are in medium-term and late gestational period.Patient＇s condition evoled expeditiously.Pristine antiviral therapy,positive obstetrics treatment,using IG and timely mechanical ventilation therapy are critical in reducing the mortality.