危重症甲型H1N1流感病例临床分析

The clinical analysis of critical H1N1 influenza

目的通过回顾性分析24例危重症甲型H1N1流感病例的特点,提高对该病危重症病例认识、诊断及治疗水平。方法对24例甲型H1N1流感危重症病例临床资料进行回顾性分析。分析该病危重症患者的一般临床表现、影像学改变、实验室检查等相关资料,提高甲型H1N1流感危重症病人早期诊断。结果 24例患者均为甲型H1N1流感危重症患者,男性10例,女性14例(其中孕妇3例,产妇1例),平均年龄(39.25±18.57)岁。其中7例患者存在基础疾病,4例患者为术后病人。14例患者经复查咽拭子,甲型H1N1病毒核酸检测转阴时间为(12.4±5.7)天。经治疗,17例患者症状改善时间平均为(11.2±12.1)天。24例患者中14例存在ARDS,22例患者伴有不同程度的肺水肿,2例患者出现多脏器功能衰竭,2例患者出现脓毒症。24例患者中除5例患者放弃治疗外,有3例(15.8%)死亡。结论大多数危重症患者就诊时流感样症状均不典型,临床表现及理化检查差异性较大,容易出现漏诊误诊。多数病人存在不同程度的ARDS、肺水肿,进展快,死亡率较高。

Objective To analyze the characteristics of 24 cases with critical H1N1 influenza and to improve the level of understanding, diagnosis, and treatment for critical severe cases. Methods 24 cases critical H1N1 influenza patients clinical data who treated in General Hospital of Ningxia Medical University between Nov. 2009 and Feb. 2010 were retrospectively analyzed. It included the clinical manifestations, imaging changes, laboratory examinations and related information of the critical patients. Result 24 patients were critically ill patients with H1N1 influenza, 10 males and 14 females （including 3 cases of pregnant women, 1 maternal）, age was 39.25 ± 18.57 years old in average. 7 patients had underlying diseases, 4 patients were postoperative patients. By review the throat swab, 14 patients H1 N1 virus nucleic acid detection clearance time was （12.4 ± 5.7） days. 17 patients symptom improved time was （ 11.2 ± 12.1 ） days after treatment. Out of 24 patients, 14 patients were developed ARDS, 22 patients with varying degrees of pulmonary edema, two patients with multiple organ failure, and two patients with sepsis. Out of 24 patients, 5 patients gave up treatment, 3 cases （ 15.8% ） were dead. Conclusion The influenza - like symptoms of most critically ill patients are not typical, the clinical manifestations and chemical examinations are more different. Most patients have different degrees of ARDS and pulmonary edema, progress fast, high mortality rate.