妊娠合并甲型H1N1流感危重症患者的临床特点及随访研究

Clinical Features and Follow-up Study of Critical Patients With Influenza A H1N1 During Pregnancy

目的了解妊娠合并甲型H1N1流感（甲流）危重症患者的临床特点,探讨甲流对患者的长期影响。方法选取2009年11月—2010年2月中国医科大学附属盛京医院收治的妊娠合并甲流危重症患者7例,收集其临床资料,分析住院期间疾病严重程度及肺部影像特点,并在出院后1、5年进行门诊随访,观察临床症状、胸部CT表现及肺功能指标变化情况。另外对存活新生儿进行临床症状及生长发育测评随访。结果 7例危重症患者年龄为22~39岁,平均为27.3岁;孕周为22~38＋6周,平均为32周;均选择了剖宫产终止妊娠,其中死亡2例,存活5例。5例存活患者气管插管时间为5~21 d,平均为13.6 d;住院时间为4~35 d,平均为19.4 d。5例存活患者随访1年后,有2例存在临床慢性呼吸道症状,胸部CT异常3例,肺弥散功能异常5例,合并小气道功能异常3例;随访5年后,仍有2例存在临床慢性呼吸道症状,胸部CT异常3例,肺弥散功能异常5例,合并小气道功能异常1例。3例存活新生儿孕周为34＋2~35＋1周,平均为34.5周;体质量为1 380~2 120 g,平均为1 881 g;未发现H1N1流感病毒感染;在随访1、5年中,生长发育与其他婴幼儿无异。结论妊娠合并甲流危重症患者出院1、5年后,胸部CT异常和肺功能障碍仍较为常见,应重视对此类患者的实验室检查以及长期随访。

Objective To investigate the clinical features of critically ill patients with influenza A H1N1 during pregnancy and long- term influence of influenza A H1N1 on gestational patients. Methods We enrolled 7 patients with influenza A H1N1 during pregnancy who were admitted into Shengjing Hospital of China Medical University from December 2009 to February 2010. Clinical data were collected,and the severity of illness and lung imaging characteristics during hospitalization were analyzed. Outpatient follow- up visits were conducted in 1 year and 5 years after discharge,during which clinical symptoms,chest CT manifestations and changes of pulmonary indicators were observed. We also examined the clinical symptoms,growth and development of surviving newborns. Results The 7 patients aged from 22 to 39 years old,with an average age of 27. 3; their number of gestational weeks were 22 ~ 38＋ 6,averagely 32; all the 7 patients chose caesarean section to end gestation,among which 2 patients died and 5 patients survived. The intubation time of the 5 surviving patients was 5 ~ 21 d,averagely 13. 6 d; the length of hospitalization was 4 ~ 35 d,averagely 19. 4 d. One year after discharge,among the 5 surviving patients,2 patients had chronic respiratory symptoms,3 patients had abnormity in chest CT,5 patients had abnormality of diffuse pulmonary function,and 3 patients had the complication of small airway dysfunction; five years after discharge,among the 5 surviving patients,2patients had chronic respiratory symptoms,3 patients had abnormity in chest CT,5 patients had abnormality of diffuse pulmonary function,and 1 patients had the complication of small airway dysfunction. For the 3 surviving newborns,the number of gestational weeks of was 34＋ 2~ 35＋ 1,averagely 34. 5; their body mass ranged from 1 380 g to 2 120 g,averagely 1 881 g; no influenza A H1N1 was noted; and no differences were detected in the growth and development during 1- year and 5- year follow- up visits,compared with other infants. Conclusion In 1 year and 5 years after the discharge of critical patients with influenza A H1N1 during pregnancy,abnormality in chest CT and pulmonary dysfunction are common,thus clinical examination and long- term follow- up on the patients should be attached importance.