重症甲型H1N1流感并发急性呼吸窘迫综合征的临床特点及危险因素分析

Clinical characteristics and the analysis on the risk factors of severe influenza A H1N1 complicated with acute respiratory distress syndrome

目的：分析重症甲型H1N1流感并发急性呼吸窘迫综合征（ARDS）的临床特点及危险因素。方法采用回顾性研究方法分析2009年10月至2010年2月首都医科大学附属北京地坛医院收治的28例重症甲型H1N1流感并发ARDS患者的临床特征，比较治愈组（13例）和死亡组（15例）患者的临床特点，采用多变量Logistic回归分析其危险因素。结果28例患者中男性14例，女性14例，年龄11～80岁，肥胖6例（21%），妊娠5例（18%），主要临床表现是高热、肌痛、呼吸困难及咯血痰。28例患者都继发细菌或真菌感染。入组患者均给予机械通气、奥司他韦抗病毒及糖皮质激素治疗，4例（14%）患者给予体外膜肺氧合（ECMO）治疗；治愈13例（46%），死亡15例（54%）。89%（25/28）患者血糖升高，基础患有糖尿病4例患者死亡，病死组患者白细胞计数及APACHEⅡ评分显著升高，死亡组继发消化道出血的比例显著高于治愈组，差别有统计学意义。结论咯血痰及APACHEⅡ评分升高是重症甲型H1N1流感并发ARDS患者死亡的高危因素。

Objective To analyze the clinical characteristics and the risk factors of severe inlfuenza A H1N1 complicated with acute respiratory distress syndrome （ARDS）.Methods Total of 28 cases of severe inlfuenza A H1N1 complicated with ARDS treated in Beijing Ditan Hospital, Capital Medical University from October 2009 to February 2010 were collected. The clinical characteristic differences between the curing group （13 cases） and dead group （15 cases） were compared, and the risk factors were analyzed by multivariate logistic regression.Result There were 14 males and 14 females whose ages were between 11-80 years old, 6 （21%） cases of them were fatty and 5 （18%） cases of them were pregnancy. The main clinical appearances were high fever, muscle pain, dyspnea and bloody sputum. All of them were secondary infected by bacteria or fungi. All the patients were treated by mechanical ventilation, oseltamivir and glucocorticoid, and 4 （14%） cases of them were treated by extracorporeal membrance oxygenation （ECMO）. Among whom, there were 13 （46%） cases cured and 15 （54%） cases died. There were 89% （25/28） of the patients’ glucose were elevated and 4 （14%） cases in the dead group were suffered from diabetes before. The number of WBC and the score of APACHEⅡ in the dead group was much higher than the other group. The proportion of upper gastrointestinal tract hemorrhage secondarily in dead group was higher than the curing group, with signiifcant difference.Conclusion Bloody sputum and high APACHEⅡ score are the risk factors of death of severe inlfuenza A H1N1 inlfuenza complicated with ARDS.