重症甲型H1N1流感合并两肺弥漫性肺炎的抢救体会

Experience of Treatment in Pneumonia Caused by Severe H1N1 Influenza

目的：分析22例重症甲型H1N1流感合并两肺弥漫性肺炎患者的临床资料,总结临床抢救体会。方法：回顾分析收治的22例重症甲型H1N1合并两肺弥漫性肺炎患者的临床资料进行。结果：22例患者年龄39.9±12.7岁,临床症状以发热、咳嗽、胸痛、呼吸困难及低氧血症为主要特征,部分患者出现消化道症状、休克;外周血白细胞计数较正常值偏低,X线胸片或胸部CT提示双侧广泛性或多肺叶性的弥漫性病变;22例患者均给予抗病毒治疗（奥司他韦75mg或150mg,每日2次口服）,全部患者均应用激素治疗,甲基强的松龙80~240mg.d-1,平均治疗剂量为136.4±58.8mg.d-1,14例患者采用无创机械通气治疗,2例患者经气管插管行机械通气治疗,2例患者死亡。结论：重症甲型H1N1流感合并两肺弥漫性肺炎患者临床症状进展快、病情重,需尽早应用抗病毒药物、合理地应用全身性糖皮质激素等治疗,同时予积极合理地氧疗,机械通气能增强氧疗的效果、迅速改善病情、改善预后。

Objective：To summarize the treatment experience of severe pneumonia caused by H1N1 influenza through analysis of clinical data of 22 patients.Methods：The clinical data of severe pneumonia caused by H1N1 influenza from 22 patients were analyzed retrospectively.Results：The 22 patients,with the average age of 39.9±12.7,exihibited fever,cough,chest pain,dyspnea and hypoxia as the main clinical features.Some patients appeared digestive symptoms and shock.Peripheral leukocyte counts were below normal.Chest X-ray or CT showed bilateral or multi-lobar lesions.All 22 patients were given antiviral treatment（Oseltamivir 75mg or150mg,bid po）.All patients were applied systemic hormone therapy with Methyl-prednisone 80 ~ 240mg/day and average dosage 136.4±58.8 mg/day.14 patients were given noninvasive mechanical ventilation and 2 patients were intubated before ventilation.2 patients died.Conclusion：Severe pneumonia caused by H1N1 has a rapid progress.Early application of anti-viral drugs as well as reasonable use of systemic corticosteroids treatment is necessary.Oxygen therapy should be carried out reasonably and mechanical ventilation can improve oxygenation,thus quickly improve patient＇s condition and prognosis further.