重症、危重症甲型H1N1流感临床指标的相关性分析

Correlation Analysis of Clinical Parameters for Types of Severe and Critically-ill Patients with Type A/H1N1 Flu

目的探讨重症、危重症甲型H1N1流感各种临床表现与相关检查指标的关系,为临床早期诊断提供依据。方法对31例重症、危重症甲型H1N1流感患者的性别、体重指数、发病至入院时间、入院时体温、住院时最高体温、血清白蛋白、血钙、心肌酶、血小板、氧合指数、胸部X线、CT等12项临床诊断指标,分别与急性肺损伤(ALI)、急性呼吸窘迫综合征(ARDS)、感染性休克、多器官功能障碍综合征(MODS)、死亡等进行Spearman相关分析。结果 ALI与住院时最高体温、入院时体温呈正相关(P<0.05);ARDS与胸部X线片病灶部位、心肌酶增高、入院时体温呈正相关,与氧合指数降低呈负相关(P<0.05);感染性休克与胸部X线片病灶部位、发病至入院时间、入院时体温呈正相关,与氧合指数降低、白蛋白减低、血钙降低、血小板减少呈负相关(P<0.05);MODS与发病至入院时间、入院时体温、胸部X线片病灶部位呈正相关,与低钙血症、氧合指数呈负相关(P<0.05);死亡与胸部X线片病灶部位、发病至入院时间、入院时体温呈正相关,与氧合指数降低、白蛋白降低、低钙血症、血小板减少呈负相关(P<0.05)。ALI、ARDS、MODS、死亡与体重指数、性别无关(P>0.05)。结论氧合指数降低、胸部X线片病灶部位增多、白蛋白降低、血钙降低、血小板减少、入院时体温升高、发病至入院时间延长是甲型H1N1流感重症与危重症患者的危险因素,密切关注上述指标可以对其进行早期识别与干预。

Objective To investigate the correlation of clinical manifestation and relative exam indexes for types of severe and critically-ill patients with type A/H1N1 flu,and screening closely related indexes to provide early clinical diagnosis with evidence.Methods Related indexes such as sexuality,body mass index（BMI）,time from onset to admission,first and maximum temperature on admission,albumin,serum calcium,myocardial enzyme,platelet,oxygenation index,chest X-ray film,chest CT of 31 patients with type A/H1N1 Flu were observed,then the results were analyzed with acute lung injury（ALI）,acute respitory distress syndrome（ARDS）,septic shock,muctiple organ dysfunction syndromel（MODS）and death by Spearman correlation analysis.Results ALI was positively correlated to first and maximum temperature on admission.ARDS was positively correlated to lesions of chest X ray,raised myocardial enzyme（P0.05）,first temperature on admission;and negatively correlated to declined oxygenation index.Septic shock was positively correlated to lesions of chest X ray,time from onset to admission,first temperature on admission（P0.05）;and negatively correlated to declined oxygenation index,hypoproteinemia,hypocalcemia,thrombocytopenia（P0.05）.MODS was positively correlated to time from onset to admission,first temperature on admission,lesions of chest X ray film,and negatively correlated to hypocalcemia and oxygenation index（P0.05）.Death was positively correlated to lesions of chest X ray,time from onset to admission,first temperature on admission,and negatively correlated to declined oxygenation index,hypoproteinemia and thrombocytopenia（P0.05）.ALI,ARDS,MODS and death were not correlated to BMI,sexuality（P0.05）.Conclusion Severe and critically-ill patients with type A/H1N1 flu are closely related to clinical indexes such as oxygenation index,chest X ray film,albumin,serum calcium,platelet,fever first on admission,prolonged time from onset to admission.Paying close attention to these indexes help to identification and intervention treatment.