重症甲型H1N1流感病例40例临床分析

Severe Influenza A(H1N1):A clinical analysis of 40 cases

目的分析甲型H1N1流感重症病例的临床特点,并对其诊治方法进行探讨。方法对2009年11月13日—12月24日河北医科大学附属哈励逊国际和平医院收治的40例甲型H1N1流感重症病例的临床症状、实验室检查、影像学特点及治疗转归情况进行回顾性分析。结果 40例患者中男14例,女26例,年龄1～68岁,平均26.5岁。仅1例有明确接触史,平均潜伏期平均3.6d;34例以发热为首发症状,所有患者均以发热、咳嗽为主要症状,肺部均可闻及湿性啰音笛槭壹觳?40.0%的患者白细胞计数升高,17.5%的患者白细胞计数降低;27.5%的患者乳酸脱氢酶水平有不同程度升高。胸部X线片及肺CT检查主要表现为肺叶或间质炎症浸润影。出现急性呼吸窘迫综合征(ARDS)13例,2例死亡。结论甲型H1N1流感诊疗的关键是早期识别重症病例,并及时给予奥司他韦治疗、综合支持治疗可取得较好的疗效。

Objective To analyze the clinical features of patients with severe influenza A （H1N1）,and to discuss the diagnosis and treatments of influenza A （H1N1）.Methods The clinical features,laboratory findings,and the image data of 40 patients with severe influenza A（H1N1）,who were admitted to the Harrison International Peace Hospital affiliated to Hebei Medical University from November 13,2009 to December 24,2009 were retrospectively analyzed.Results The 40 patients consisted of 14 males and 26 females,aged from 1 to 68 years （mean age,26.5 years）.Only one patient had definite contact history,the mean latency was 3.6 days.The most common initial symptoms and physical signs were fever,cough and rales in the lung Blood routine showed that 40.0% of patients had an increased neutrophil ratio,17.5% had a decreased neutrophil ratio,27.5% had an increased level of lactic dehydrogenase.The major findings of lung CT were bilateral mixed interstitial or alveolar infiltrating shadows.13 patients had acute respiratory distress syndrome （ARDS）,and 2 died of both ARDS and multiple organ dysfunction syndrome （MODS）.Conclusion Early identification of severe influenza A（H1N1） patients and early treatment with Oseltamivir are the keys for diagnosis and treatment,and comprehensive therapy and supporting therapy can achieve better therapeutic effects.