55例甲型H1N1流感危重症的监护护理

Critical care nuring on 55 cases of severe patients with influenza A(H1N1) infection

目的探讨甲型H1N1流感危重症患者的监护护理策略。方法回顾性总结2009年10月4日至12月20日本院ICU收治的甲型H1N1流感危重症病例,描述其发病情况、临床特征、重症监护要点和救治护理措施。结果 55例甲型H1N1流感危重症患者中,重症肺炎所致严重呼吸衰竭(PaO2/FiO2<300)者49例(89.1%),无创机械通气10例,有创机械通气25例,体外膜氧合(ECMO)治疗4例;合并急性肾损伤(AKI)行连续肾脏替代治疗(CRRT)者13例(23.6%);死亡14例(25.45%)。结论通过对甲型H1N1流感危重症病例临床特征和治疗反应的分析,总结出加强早期呼吸监测,机械通气及气道管理,以及其他器官支持要点等重症护理策略。

Objective To study the strategy of critical care nursing on severe patients with influenza A（H1N1）infection.Methods Incidence,clinical characteristics,treatment and outcomes of severe patients with influenza A（H1N1）infection admitted to ICU in Beijing Ditan hospital between October 4 and December 20 in 2009 were analyzed,retrospectively.Results Of the 55 severe patients with influenza A（H1N1）infection,49（89.1%）had severe pneumonia associated with respiratory failure（PaO2/FiO2 300 mmHg）,10 received non-invasive mechanical ventilation,25 received invasive mechanical ventilation,4 received extracorporeal membrane oxygenation（ECMO）therapy and 13（23.6%）received continuous renal replacement therapy（CRRT）due to complication of acute kidney injury（AKI）and 14（25.45%）died.Conclusions By analyzing clinical characteristics and responses to treatment of severe patients with influenza A（H1N1）infection,critical care nursing strategies on respiratory monitoring and observation at early stage,mechanical ventilation and airway management and major points of other organ supporting were proposed.