目的 研究新疆地區(qū)甲型H1N1 流感重癥病例的臨床特點, 分析與預后相關的因素。方法 對2009 年9 月至2009 年12 月新疆地區(qū)五家大型綜合醫(yī)院及傳染病?？漆t(yī)院收治的經(jīng)實驗室確診的63 例甲型H1N1 流感重癥患者的臨床資料進行回顧性總結, 分析臨床一般情況、并發(fā)癥、治療情況及預后, 按預后將患者分為存活組與死亡組。結果 新疆地區(qū)甲型H1N1 流感重癥患者63例, 存活組46 例, 男26 例, 女20 例; 年齡( 28. 48 ±19. 59) 歲; 合并重癥肺炎30 例( 63. 8% ) , MODS 10例( 43. 48% ) ; 治愈29 例( 63. 04%) , 好轉15 例( 32. 61% ) , 放棄治療2 例。死亡組17 例, 男11 例, 女6 例; 年齡( 39. 47 ±21. 23) 歲; 合并肺炎100% ,MODS 94. 12% 。存活組與死亡組患者白細胞、中性粒細胞、淋巴細胞、血紅蛋白、血小板、肌酸激酶同工酶、羥丁酸脫氫酶、尿素氮、活化部分凝血活酶時間( APTT) 、國際標準化比值( INR) 、鉀離子、鈉離子、氯離子、PaO2、PaCO2 、血氧飽和度, 兩組比較差異均無統(tǒng)計學意義( P gt;0. 05) , 天冬氨酸轉氨酶、丙氨酸氨基轉移酶、肌酸激酶、乳酸脫氫酶、白蛋白、肌酐及pH值兩組比較差異有統(tǒng)計學意義( P lt;0. 05) , 并發(fā)MODS 比率差異有統(tǒng)計學意義( P lt; 0. 05) 。結論 甲型H1N1 流感重癥患者以年輕人多見, 臨床表現(xiàn)以高熱、咳嗽、咳痰多見, 常合并肺炎及ALI/ARDS, 部分患者可治愈好轉。合并有多器官損害的患者預后差。發(fā)病早期有效應用抗病毒藥物及小劑量激素、合理使用機械通氣可改善預后。
引用本文： 何元兵 ,張燦花,郁秀莉,李麗,焦克崗,王在義,齊曼古力吾守爾,彭鵬,買買提艾力,張躍新,宋國平,凌敏,吳彥青,湯勇,林勇. 新疆地區(qū)甲型H1N1 流感重癥患者臨床分析. 中國呼吸與危重監(jiān)護雜志, 2010, 9(6): 583-586. doi: 復制
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- 1. Centers for Disease Control and Prevention ( CDC) . Swine Influenza A( H1N1 ) infection in Two Children--Southern California, March-April 2009 .Morb Mortal Wkly Rep, 2009, 58: 400 -402.
- 2. 中華人民共和國衛(wèi)生部. 甲型H1N1 流感診療方案( 2009 年試行第3 版) . 中華臨床感染病雜志, 2009, 2: 257 -259.
- 3. Centers for Disease Control and Prevention ( CDC) . Intensive-care patients with severe novel influenza A ( H1N1 ) virus infection--Michigan, June 2009 .Morb Mortal Wkly Rep, 2009, 58: 749-752.
- 4. Centers for Disease Control and Prevention( CDC) . Update: Novel Influenza A ( H1N1 ) Virus Infections--Worldwide, May 6, 2009 .Morb Mortal Wkly Rep, 2009, 58 : 453-458.
- 5. Novel Swine-Origin Influenza A ( H1N1) Virus Investigation Team,Dawood FS, Jain S, et al. Emergence of a Novel Swine-Origin Influenza A ( H1N1) Virus in Humans. N Engl J Med, 2009, 360 :2605-2615.
- 6. Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, et al.Pneumonia and Respiratory Failure from Swine-Origin Influenza A( H1N1 ) in Mexico. N Engl J Med, 2009, 361: 680 -689.
- 7. 姚蓉, 劉亞玲, 陳斌, 等. 四川省135 例重癥甲型H1N1 流感病例的臨床分析. 中國呼吸與危重癥監(jiān)護雜志, 2010, 9: 7 -11.
- 8. Harer SA, Bradley JS, Englund JA, et al. Seasonal influenza in adults and children--diagnosis, treatment, chemoprophylaxis, and institutional outbreak management: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis, 2009 , 48 :1003-1032.
- 9. Sullivan SJ, Jacobson RM, Dowdle WR, et al. 2009 H1N1 Influenza.Mayo Clin Proc, 2010, 85: 64-76 .
- 10. Centers for Disease Control and Prevention ( CDC) . Patients hospitalized with 2009 pandemic influenza A ( H1N1) - New York City, May 2009. Morb Mortal Wkly Rep, 2010 , 58: 1436-1440.
- 11. Namendys-Silva SA, Hernández-Garay M, Rivero-Sigarroa E. Noninvasive ventilation for critically ill patients with pandemic H1N1 2009 influenza A virus infection. Crit Care, 2010, 14: 407.