妊娠晚期合并重症甲流救治成功1例

Severe influenza A(H1N1)in late pregnancy:a case report

妊娠妇女是甲型流感病毒(甲流)易感人群,一旦感染重症甲流病死率较高.昆明医科大学附属第二医院重症医学科于2018年12月16日收治1例妊娠晚期(孕1产0,孕30+2周)合并重症甲流患者,该患者在吸入氧浓度(FiO2)1.00、呼气末正压(PEEP)15 cmH2O(1 cmH2O=0.098 kPa)、潮气量4~6 mL/kg支持下,脉搏血氧饱和度(SpO2)仅能维持在0.85左右,不具备手术条件.经抗感染、机械通气、免疫调理、肠内营养支持、肝素抗凝预防静脉血栓、血流动力学监测下液体负平衡、保肝等器官功能支持治疗,最终母婴得到成功救治,报告救治过程,以期为此类疾病的临床诊治提供一定的参考.

Pregnancy has increased susceptibility to H1N1 influenza virus infection.Maternal influenza infection is associated with increased risk of morbidity and mortality.A case of influenza A(H1N1)during late pregnancy(pregnancy 1,birth 0,pregnancy 30+2 weeks)was admitted to the Second Affiliated Hospital of Kunming Medical University on December 16th,2018.The patient was set on mechanical ventilation with a FiO2 of 1.0,a positive end-expiratory pressure(PEEP)of 15 cmH2O(1 cmH2O=0.098 kPa),and a tidal volume of 4-6 mL/kg(ideal body weight).However the pulse oxygen saturation(SpO2)could only be maintained at about 0.85.The disease was controlled by the treatments of anti-infection,mechanical ventilation,immune therapy,nutritional support,preventive anticoagulant treatment by heparin sodium,adequate negative fluid balance,and other organ support therapy.This article introduced the treatment process of the patient in detail,and provided experience for clinical treatment.