重症及危重症甲型H1N1流感74例临床分析

The clinical analysis of 74 cases in severe and critical H1N1 influenza

目的分析ICU救治甲型H1N1流感重症及危重症患者的临床特点。方法回顾性分析174例H1N1患者的临床资料,对其发病特点、治疗方法及转归等资料进行分析。结果 74例重症及危重症甲型H1N1患者主要临床特点为高热,呼吸困难,白细胞数及炎症反应指标升高,免疫功能紊乱,胸部影像改变特点为进展快,双肺多叶受累,以广泛肺实质浸润为主,部分病例出现肺间质渗出。结论甲型H1N1流感重症及危重症病情进展快,以呼吸困难、低氧血症为突出表现,肺部病变广泛,进展迅速,妊娠、有基础疾病或合并细菌感染是死亡的高危因素,早期奥司他韦抗病毒及合理使用糖皮质激素、呼吸支持、控制混合感染等综合治疗是降低病死率的关键。

Objective To analyze the clinical features of severe and critical H1N1 influenza.Methods The clinical data of 74 cases of H1N1 influenze were retrospectively analyzed.The clinical characteristics,treatment,and clinical outcome were analyzed.Results The clinical characteristics of 74 cases of severe and critical H1N1 influenza were high fever,difficulty breathing,white blood cell count and inflammatory reaction index increased,autoimmune dysfunctions.The characteristics of imaging changes were progress fast,double lung involvement,give priority to lung parenchyma infiltrated.Some cases were interstitial lung infiltrates.Conclusion The extrude performance are progress fast,difficult breathing and hyoxemia.The death risk factors are lung diseases,progress fast,gestation,basic diseases or the merge bacterium infection.Oseltamivir combined with glucocorticoid,the breath support and control mixed infection is the key for decrease the mortality rate.