早期抗病毒治疗对妊娠合并重症甲型H1N1流感患者围产预后的影响

Effect of early antiviral treatment on perinatal prognosis of the pregnant women with severe H1N1 influenza virus infection

目的:研究早期及时抗病毒治疗妊娠合并重症甲型H1N1流感患者对母儿围产预后的影响。方法:回顾性分析2009年11月7日～2010年1月30日于中国医科大学附属盛京医院就诊的妊娠合并重症甲型H1N1流感患者18例,比较48h内用药(早期用药组,n=6)与48h后用药(晚期用药组,n=12)患者的妊娠结局及预后相关指标,包括住院时间、进行机械通气时间、术前氧合指数、肌酸激酶(CK)、乳酸脱氢酶(LDH)水平和新生儿预后情况。结果:早期用药组均痊愈,晚期用药组2例死亡。与早期用药组相比,晚期用药组平均住院时间长(P=0.009),进行机械通气时间多(P=0.028),CK水平高(P=0.018);而两组间术前氧合指数、LDH水平则无统计学差异(P>0.05)。早期用药组新生儿出生后均无窒息症状,晚期用药组胎死宫内3例,1例死亡和1例轻度窒息,7例Apgar评分10分。所有存活新生儿生后3天进行咽拭子检查均为阴性,且无流感表现,6例继续妊娠至足月后分娩的新生儿均未发现畸形。随访2～9个月,婴儿体格发育和智力发育同正常同龄儿。结论:发病48h内及时应用药物治疗的重症患者预后明显优于发病48h后应用药物治疗的患者,且前者新生儿的预后亦明显优于后者。采用奥司他韦抗病毒治疗妊娠中期和晚期的甲型H1N1流感患者对母儿均是安全的,未见致畸作用。若疑似为妊娠合并甲型H1N1的患者应及时尽早给予抗病毒治疗,可以获得较好的母儿预后。

Objective：To study the effect of early and timely antiviral treatment on perinatal prognosis of the pregnant women with severe H1N1 influenza virus infection.Methods：18 pregnant women with severe H1N1 influenza virus infection who visited the hospital from November 7,2009 to January 30,2010 were analyzed retrospectively.The pregnancy outcomes,prognosis-related indexes（including hospitalization time,the duration time of mechanical ventilation,preoperative oxygenation index,creatine kinase level and lactate dehydrogenase level） and prognosis of the neonates were compared between early administration group（within 48 hours,6 cases） and late administration group（after 48 hours,12 cases）.Results：The cases in early administration group were cured,2 cases died in late administration group.Compared with early administration group,the average hospitalization time was longer（P=0.009）,the duration time of mechanical ventilation was longer（P=0.028）,the level of creatine kinase was higher（P=0.018） in late administration group.There was no significant difference in preoperative oxygenation index and lactate dehydrogenase level between the two groups（P〉0.05）.The neonates in early administration group had no asphyxia after birth;in late administration group,3 cases with intrauterine death,1 case with neonatal death and 1 case with mild asphyxia were found,the Apgar score of 7 cases was 10.The results of pharyngeal swab examination on the third day after birth were negative among all the live neonates,and the live neonates had no influenza;6 cases continued pregnancy till term delivery,all the neonates were not found with abnormalities;the infants were followed up for 2-9 months,their physical development and intellectual development were as same as those of normal infants.Conclusion：The prognosis of severe patients treated with drugs within 48 hours is superior to that of patients treated with drugs after 48 hours,the prognosis of the neonates born by the former is superior to that of the neonates born by the latter.Oseltamivir is safe for the mothers and their infants in treatment of influenza A（H1N1） during the second and third trimester of pregnancy,teratogenicity is not found.For the pregnant women with H1N1 influenza virus infection,early antiviral treatment may achieve a good prognosis of mothers and their infants.