甲型H1N1流感合并急性低氧性呼吸衰竭

Clinical Study of Influenza A(H1N1)-Related Acute Hypoxemic Respiratory Failure

目的:研究甲型H1N1流感合并急性低氧性呼吸衰竭患者的临床特征以及无创正压通气(NIV)联合中剂量糖皮质激素在治疗中的作用。方法:分析34例甲型H1N1流感合并急性低氧性呼吸衰竭患者的临床资料。所有患者采用无创正压通气联合糖皮质激素(2mg.kg-1.d-1)的治疗方案。随访治疗后的血常规、氧合指数、肺部影像学检查的动态变化。将治疗前后患者急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)进行比较。结果:患者住重症监护室的中位天数为12d。30例(88.2%)患者经治疗后症状和影像学检查结果明显好转出院,4例(11.8%)患者死亡。34例患者经NIV治疗2h后,PaO2/FiO2中位数由132.5mmHg上升至246mmHg。NIV联合激素治疗5d后,APACHEⅡ中位数由11分降为0.5分。结论:无创正压通气联合中剂量糖皮质激素的治疗方案对甲型H1N1流感合并急性低氧性呼吸衰竭患者有效且无明显不良反应。

Objective：To investigate the clinical feature and effect of combination of non-invasive ventilation and moderate-dose corticosteroids in the treatment of influenza A（H1N1）-related acute hypoxemic respiratory failure.Methods：Thirty-four influenza A（H1N1）-related acute hypoxemic respiratory failure patients were treated with combination of non-invasive ventilation and corticosteroids（2 mg/kg/d）.Their clinical data were analyzed.We take a close follow up of whole blood test,PaO2/FiO2 and chest radiographs.The changes of acute physiology and chronic health evaluationⅡ（APACHEⅡ） before and after the therapy were detected.Results： The median duration of stay in intensive care unit（ICU） was 12 days.Thirty（88.2%） patients survived to hospital discharge and four（11.8%） patients passed away.Two hours after NIV therapy,the median of PaO2/FiO2 increased significantly from 132.5mmHg to 246 mmHg.On admission,the median APACHE II score of patients was 11,while at the 5 th day in ICU median APACHE II score decreased to 0.5.Conclusions： Non-invasive ventilation combined with moderate-dose corticosteroids is a safe and effective way to treat the patients with influenza A（H1N1）-related acute hypoxemic respiratory failure without apparent adverse effect.