2017—2018年冬春季重症流感病毒性肺炎所致急性呼吸窘迫综合征的临床特点及预后危险因素分析

Clinical characteristics of influenza acute respiratory distress syndrome in 2017 to 2018

目的总结重症流感病毒性肺炎所致急性呼吸窘迫综合征(ARDS)患者的临床特点,分析预后危险因素。方法收集2017年11月至2018年2月因重症流感病毒肺炎所致ARDS住我院呼吸重症监护病房(RICU)患者48例,其中男34例,女14例,年龄16~78岁,平均(49±15)岁,根据预后分为存活组和死亡组。存活组30例,男20例,女10例,年龄16~64岁,平均(44±14)岁;死亡组18例,男14例,女4例,年龄35~78岁,平均(57±14)岁。用多因素logistic回归分析法分析住院患者的病死率及其危险因素。结果48例中,确诊为甲型流感病毒感染31例,乙型流感病毒感染3例,甲型和乙型流感病毒混合感染2例,临床诊断12例;住院期间死亡18例,存活30例。26例患者合并其他病原微生物性肺炎,其中17例曲霉性肺炎,10例鲍曼不动杆菌肺炎,6例金黄色葡萄球菌肺炎,4例肺炎克雷伯杆菌肺炎,铜绿假单胞菌和肺炎链球菌肺炎各1例;16例发生院内感染。多因素logistic回归分析结果示年龄(OR=1.086,95%CI为1.016~1.161,P=0.015)、出现流感样症状至住RICU时间(OR=1.196,95%CI为1.031~1.388,P=0.018)和PaO2/FiO2降低(OR=0.973,95%CI为0.951~0.995,P=0.017)与住院病死率独立相关。结论2017—2018年冬春季重症流感肺炎所致ARDS以甲型流感病毒为主;合并感染,尤其是侵袭性肺曲霉感染率高,住院病死率高;院内感染发生率高,与高病死率显著相关;PaO2/FiO2降低、年龄增加、出现流感样症状至住RICU时间延长是影响住院病死率的独立危险因素。

Objective To describe the clinical characteristics of acute respiratory distress syndrome (ARDS) caused by severe influenza virus in our hospital. Method From November 2017 to February 2018, 48 patients were diagnosed with ARDS caused by influenza virus pneumonia. There characteristics, treatment, and outcomes were summarized and analyzed. According to the prognosis, the patients were divided into a survival group and a death group for comparative analysis. The multivariable logistic regression analysis was used for risk factors of hospital mortality. Result Thirty-one patients were confirmed to have influenza A virus infection, 3 influenza B virus, 2 mixed infection, while 12 patients were diagnosed by clinical criteria. Eighteen patients died, with a mortality of 38%. Twenty-six patients (54%) were co-infected by other pathogenic microorganisms, including 17 cases of invasive aspergillus infection. Sixteen patients (33%) acquired nosocomial infection that significantly correlated with the hospital mortality, P=0.003. Multivariable logistic regression analysis showed that higher age (OR=1.086, 95% CI: 1.016-1.016), P=0.015), longer duration of flu-like symptoms to RICU time (OR=1.196, 95% CI: 1.031-1.031, P=0.018) and lower PaO2/FiO2 (OR=0.973, 95% CI: 0.951-0.951, P=0.017) were independent risk factors for hospital mortality. Conclusion In the flu season of 2017-2018, the patients of ARDS caused by severe influenza pneumonia were mainly influenza A virus, with a mortality of 38%. Co-infection was very common, especially aspergillus infection. Nosocomial infection was common and significantly correlated with high mortality. Lower PaO2/FiO2, higher age and the longer duration from influenza-like symptoms to RICU was independent risk factors for high hospital mortality.