目的 探討孕產(chǎn)婦甲型H1N1 流感重癥病例的臨床特征和治療方法。方法 對2009年10 月至12 月收治的9 例孕產(chǎn)婦甲型H1N1 流感重癥確診病例的臨床特征和治療過程進行回顧性分析。結(jié)果 9 例患者中, 7 例孕婦, 2 例產(chǎn)婦, 7 例孕婦中3 例在住院期間實施了剖宮產(chǎn)手術(shù)。9 例患者均出現(xiàn)發(fā)熱, 7 例患者發(fā)熱持續(xù)達3 d 以上。9 例均有咳嗽、咯痰, 7 例呼吸困難。5 例肺部可聞及濕啰音。乏力、肌肉酸痛等全身癥狀不重, 不伴消化道癥狀。3 例患者白細胞計數(shù)降低, 6 例中性粒細胞升高, 7 例淋巴細胞降低。肝功異常4 例。心肌酶指標異常5 例。低氧血癥8 例, 5 例PaO2 低于40 mm Hg。9 例患者胸部X 線片及CT 檢查均有雙肺炎改變。9 例患者均在入院后服用奧司他韋抗病毒治療。8 例給予抗生素治療。5 例重癥呼吸衰竭及雙肺重癥肺炎的患者給予了糖皮質(zhì)激素治療。5 例重癥患者使用了無創(chuàng)呼吸機治療,1 例后改為有創(chuàng)呼吸機治療, 最終死亡。其余患者及剖宮產(chǎn)后
的嬰兒均存活。結(jié)論 孕產(chǎn)期婦女出現(xiàn)流感樣癥狀后較易發(fā)展為重癥病例, 病程進展快, 病情重, 甚至危及孕產(chǎn)婦生命。死因多為肺炎及隨后出現(xiàn)的急性呼吸窘迫綜合征, 應當給予高度重視。
引用本文： 鮑永霞,王威,王晶,曲波,趙勇華,黃海英. 九例孕產(chǎn)婦甲型H1N1 流感重癥病例臨床分析. 中國呼吸與危重監(jiān)護雜志, 2010, 9(3): 234-238. doi: 復制
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- 5. Goodnight WH, Scoper DE. Pneumonia in pregnancy. Crit Care Care Med, 2005, 33( 10 Suppl) : S390-S397.
- 6. Lim WS, Macfarlane JT, Colthorpe CL. Treatment of community acquired lower respiratory tract infections during pregnancy. Am J Respir Med, 2003 , 2: 221-233 .
- 7. Laibl V, Sheffield J. The management of respiratory infections during pregnancy. Immunol Allergy Clin North Am, 2006, 26: 155-172 .
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- 9. 衛(wèi)生部. 衛(wèi)生部《孕產(chǎn)期婦女甲型H1N1 流感防治指南( 試行) 》, http: / /www. gov. cn/gzdt /2009-12 /30 / content-1500044 .htm.
- 10. 張建平, 王蘊慧, 陳雷寧, 等妊娠中晚期合并重癥急性呼吸綜合征的臨床分析. 中華婦產(chǎn)科雜志, 2003, 38 : 516-520.