31例甲型H1N1流感重症与危重症患者临床特点和救治策略

Clinical characteristics and treatment strategies for 31 severe and critically ill patients with influenza A(H1N1)

目的探讨甲型H1N1流感重症与危重症患者的临床特点和救治策略。方法回顾性总结分析31例甲型H1N1流感重症与危重症患者的临床表现、实验室检查、影像学改变、治疗及转归等资料。结果重症与危重症组患者均有发热、咳嗽、咳痰及乏力等症状,可闻及湿啰音、哮鸣音,白细胞计数尤其中性罯赴俜直壬撸馨拖赴俜直冉档停甯平?低。危重症患者突出表现为呼吸困难,少数出现胸痛、发绀及咳血痰,入院后生命体征变化较明显,血氧分压及氧合指数下降,心肌酶及血乳酸升高,临床表现为重症肺炎、低氧血症甚至呼吸衰竭,其中4例血小板计数呈进行性下降,最终死亡。结论重症与危重症患者在临床表现、实验室检查、影像学改变、病情演变及治疗转归等方面存在差异,病情轻重缓急亦不同,应采取有针对性的救治策略。

Objective To investigate the clinical characteristics and treatment strategies for severe and critically ill patients with influenza A （H1N1）. Method The data including clinical manifestations, laboratory examination, imaging changes, treatment and prognosis in 31 severe and critically ill patients with influenza A （H1N1） were retrospectively analyzed. Results For all the patients in both severe patient group and critically ill patient group, symptoms were characterized by fever, cough, expectoration and fatigue. Moist rales and wheezing could be heard in the check-up. White cell count, especially the neutrophil percentage, increased, while lymphocyte percentage and the serum calcium concentration decreased. The critically ill patients were mainly characterized by dyspnea, and a few had chest pain, cyanosis and bloody expectoration. In this group, vital signs changed obviously after admission, and partial pressure of oxygen and oxygenation index decreased, while the myocardial enzymes and blood lactate increased. Clinical manifestations were presented with severe pneumonia, hyoxemia and even respiratory failure. Four critically ill patients showed degressive platelet and finally died. Conclusions There are great differences in clinical manifestations, laboratory examination, imaging changes, disease progression, treatment and prognosis between the severe patients and the critically ill patients. Specific treatment strategies should be adopted according to the severity of the disease condition.