危重症甲型H1N1流行性感冒病毒肺炎的临床特征——附17例报告

Clinical features of severe influenza A(H1N1) virus pneumonia

目的:探讨危重症甲型H1N1流行性感冒病毒(甲流)肺炎患者的主要临床特点,分析各临床检验指标与病情严重程度的关系。方法:收集入住呼吸重症监护病房(RICU)的17例危重症甲流肺炎患者的临床资料,归纳分析其临床特征。结果:17例患者以发热、咽痛、咳嗽、肌肉酸痛为主要症状。双肺多发实变影12例(71%)。入院后白细胞为(3.4～25.1)×109/L,中性粒细胞(2.72～21.84)×109/L,中性粒细胞比例58.6%～96.4%,淋巴细胞5.1%～21.6%。CRP 34.6～381.9 mg/L,乳酸脱氢酶(LDH)310～820 U/L,白蛋白<30 g/L10例(59%),ALT升高6例(35%),血清肌酐升高5例(29%),脑钠肽升高4例(24%)。氧合指数<300 mm Hg 13例(76%)。均予奥司他韦治疗,气管插管机械通气支持治疗3例(18%)。死亡2例(12%),均为男性,均为气管插管机械通气者。结论:LDH、CRP升高、炎性细胞增多提示危重症甲流肺炎患者肺部损害加重;机械通气支持治疗对于部分肺内广泛实变者效果不理想,且相关的并发症是部分患者病情加重或死亡的促发因素。

Objective： To investigate the main clinical features of patients with severe influenza A（ H1N1 ） in- fluenza virus pneumonia and the relationship between indicators of clinical tests and severity of the disease. Methods： A retrospective analysis on 17 patients with severe H1NI influenza virus pneumonia, who was admitted to a respiratory intensive care unit （RICU）, was carried out. Results： The main symptoms were progressive shortness of breath, cough and myalgia. Multiple lung consolidation shadows in chest X-ray were observed in 14 patients. The baseline white blood cell count, neutrophil count, neutrophil percentage, lymphocyte percentage, CRP concentration and lactate dehydrogenase （LDH） concentration were ranging of （3.4 - 25.1 ） × 10^9/L, （2. 72 - 21.84） × 10^9/L, 58.6% -96.4%, 5. 1% -21.6%, 34. 6 -381.9 mg/L and 310 -820 U/L, respectively. Low albumin concentration （ 〈30 g/L）, elevated alanine aminotransferase （ALT）, elevated serum creatine, elevated brain natriuretic peptide, impaired oxygenation index （ 〈 300 mm Hg） , mechanical ventilation and even deaths were recorded in 10（59%）, 6（35%）, 5（29%）, 4（24%）, 13（76%）, 3（18%） and 2（12%） cases, respectively. Ratients who died were male and received mechanical ventilation. Conclusion： Elevated LDH, CRP and inflammatory cells indicate aggravated lung injury in patients with severe H1N1 influenza virus pneumonia. Mechanical ventilation provides little effect in patients with of pulmonary consolidation, even and the related complications may lead to exacerbation or death in some of them.