肥胖型危、重症甲型H1N1流感8例临床分析

目的分析肥胖型甲型H1N1流感患者的临床表现,探讨肥胖在甲型H1N1流感中的作用以及临床治疗特点。方法对南通市区医院确诊的8例肥胖型危重症甲型H1N1流感患者的流行病学资料、临床表现、实验室检查、胸部X线和肺部CT表现进行回顾性分析。结果 8例患者中,男2例(2/8),女6例(6/8),体重指数≥40kg/m2者5例(5/8),≥30kg/m2者3例(3/8)。所有病例均患有一种及以上基础疾病。并发急性肺损伤者1例(1/8),急性呼吸窘迫综合征者3例(3/8),重症肺炎者2例(2/8),双下肢深静脉栓塞者1例(1/8),肺性脑病者1例(1/8)。8例患者均给予抗病毒(奥司他韦75mg或150mg每日2次口服)联合抗感染治疗,应用糖皮质激素治疗者1例(1/8),出现呼吸衰竭者8例(8/8),采用无创呼吸机通气治疗者8例(8/8),后经气管插管行机械通气治疗者2例,胸部X线或肺部CT表现为双肺多肺叶实变影8例(8/8)。结论肥胖患者的肺部特征是甲型H1N1流感病毒和细菌易于感染的基础,合并基础疾病较多,促进病情进展。抗病毒联合抗感染、呼吸机纠正呼吸衰竭是治疗的关键。

Objective To analyze the clinical manifestations of patients in obese patients with Influenza A（H1N1）.Investigate the role of obesity in Influenza A（H1N1）and clinical feature of therapies.Methods The epidemiologic data,clinical manifestations,laboratory examination results,and chest X-ray/CT findings of confirmed 8 patients in obesity in our department were retrospectively analyzed.Results Totally 8 cases（2 men and 6 women） were enrolled.The mean age of 8 patients was（57.4±6.7） years,body mass index（BMI） ≥30）,3cases,（BMI）≥ 40,5cases.All of cases have one or more than one chronic underlying diseases.complicated with 1 case of acute lung injury（ALI）（1/8）,3 case of acute respiratory distress syndrome（ARDS）（3/8）,2 cases of severe pneumonia（2/8）,1 case of deep vein phlebothrombosis of double lower extremity（1/8）,1 case of pulmonary encephalopathy（1/8）,8 patients were treated with antiviral therapy（Oseltamivir 75mg,4cases（4/8）,150mg,4cases（4/8）,oral administration,2 times per day）,and anti-bacterial,1cases with hormone therapy（1/8）,8patients presenced respiratory failure（8/8）,all of cases were treated with mechanical ventilation（8/8）,of which 2 cases with mechanical ventilation after endot racheal intubation（2/8）.Chest X-ray/CT showed scattered multi-lobe or multi-segment inflammations or large patchy high-density shadow in double lung.Conclusion The feature of lung in obese patients was the base of infected with Influenza A（H1N1） and bacterial,and combined with several underlying diseases were benefit to the pathogenetic condition exacerbations.Anti-viruses combined with anti-bacterial and ventilator using in the respiratory failure state were the critical treatment.