甲型H1N1流感病毒性肺炎呼吸衰竭危险因素分析

Risk factors for influenza A(H1N1) pneumonia with respiratory failure

目的分析我院收治的46例甲型H1N1流感病毒性肺炎(甲流肺炎)患者的临床特点,探讨其发展为呼吸衰竭的危险因素。方法收集我院2009年10月至2010年1月收治的46例甲型H1N1流感病毒性肺炎患者的一般情况、症状、体征、实验室结果,治疗方案等资料,并分为呼吸衰竭组和非呼吸衰竭组。结果 14例甲流肺炎患者发生呼吸衰竭,其中1例自动出院。所有非呼吸衰竭患者痊愈。呼吸衰竭组与非呼吸衰竭组患者在呼吸困难(10例vs6例)、咯血(10例vs5例)、淋巴细胞减少(158±18)/μlvs(192±26)/μl、氧合指数(182±23)mmHgvs(426±45)mmHg、器官功能不全评分中位数(4vs1)、入院时胸片浸润影(2.3±1.3)vs(1.2±0.8)存在显著差异(P<0.01)。与非呼衰竭组相比,呼吸衰竭组患者住院中位时间长(26 dvs5 d,P=0.000 1)。多因素Logistic回归分析显示甲流肺炎患者发生呼吸衰竭与发病至首剂奥司他韦超过48 h,淋巴细胞计数≤600/μl,入院时SOFA评分≥4分,X线检查肺部浸润影≥75%相关。结论发病至首剂使用奥司他韦超过48 h,淋巴细胞计数≤600/μl,入院时SOFA评分≥4分,X线检查肺部浸润影≥75%是甲流肺炎发生呼吸衰竭的危险因素。

Objective To analyze the clinical features of 46 hospitalized patients with influenza A（H1N1） pneumonia and to study the risk factors for the development of respiratory failure.Methods Medical records of 46 hospitalized patients with influenza A（H1N1） pneumonia were collected and analyzed,including basic status,symptoms,physical signs,laboratory data,therapeutic regimens,etc.The patients were divided into two groups： a respiratory failure group and a non-respiratory failure group.Results Of the 46 patients,14 developed respiratory failure,with 1 dead case.All of the non-respiratory failure patients survived.Presence of dyspnea（10 cases vs 6 cases）,presence of hemoptysis（10 cases vs 5 cases）,lymphopenia（158±18/μl vs 192±26/μl）,PaO2/FiO2 ratio（182±23 mmHg vs 426±45 mmHg）,SOFA score（4 vs 1）,and score of infiltration on chest X-ray at admission（2.3±1.3 vs 1.2±0.8） were significantly different between the respiratory failure group and non-respiratory failure group（P0.01）.The patients with respiratory failure had longer ICU stay than those without respiratory failure（26 d vs 5 d;P=0.000 1）.A multivariate logistic regression analysis showed a correlation between the development of respiratory failure and the following factors： SOFA score at admission ≥4,initial lymphocyte count ≤600/μl,duration from onset to initial administration of oseltamivir 48 h,and infiltration on chest X-ray at admission ≥75%.Conclusion The risk factors for influenza A（H1N1） pneumonia with respiratory failure includes duration from onset to initial administration of oseltamivir 48 h,initial lymphocyte count ≤600/μl,SOFA score at admission ≥4,and infiltration on chest X-ray at admission ≥75%.