妊娠合并甲型H1N1流感危重症临床特点分析

目的分析妊娠合并甲型H1N1流感危重症的临床特点。方法分析2009年5月15日-12月20日我院收治的6例甲型H1N1流感危重症孕妇的临床表现、实验室检查及治疗等相关资料。结果6例年龄22．27（24．7±2．1）岁；发病时孕周25～36（30．5±3．5）周，均为妊娠晚期发病；4例痊愈出院，2例死亡。主要症状有发热、咳嗽、呼吸困难、咳血痰。HGB和ALB明显下降，LDH、d～HBDH和CRP均明显升高，T淋巴细胞亚群（CD3＋／CD4＋／CD8＋）细胞计数均下降。6例均合并肺炎和急性呼吸窘迫综合征（acute respiratory distress svndrome，ARDS），其中4例接受机械通气治疗，3例同时接受体外膜肺氧合治疗。3例行急诊剖宫产手术，1例因胎死宫内后自行分娩出死胎，其余2例继续妊娠。结论甲型H1N1流感可能导致孕妇病情加重，妊娠晚期患者易进展为危重症。危重症特征性表现为咳血痰和呼吸困难。合并肺部感染和ARDS的危重症患者大多需要机械通气治疗，其病死率较高。

Clinical features of critically ill pregnant patients with influenza A (H1N1)

objective To investigate the clinical features of critically ill pregnant patients with influenza A （H1N 1）. Method The data including clinical manifestations, laboratory findings and treatment of six critically ill pregnant patients with influenza A （H1N1）, who were admitted to our hospital from May 15 to Dec. 20, 2009, were analyzed. Results The six critically ill pregnant patients ranged from 22 to 27 （24.7±2.1） years old, and were infected with influenza A （H1N1） at week 25-36 of gestation （ 30.5±3.5 weeks） （the third trimester）. Four patients were cured and discharged from hospital, and the other two died. The most common symptoms were fever, coughing, shortness of breath and hemoptysis. The significant decline in hemoglobin and albumin levels, the significant increase in the levels of lactate dehydrogenase, α-hydroxybutyrate dehydrogenase and C-reactive protein, and the decrease in T lymphocyte subpopnlation counts were found in the critically ill patients. All the six patients developed pneumonia and aeute respiratory distress syndrome （ARDS）, among whom four required mechanical ventilation, and three required extracorporeal membrane oxygenation additionally. Of the six patients, three had emergency caesarean section preformed, one underwent a vaginal delivery of a dead fetus, and the other two continued their pregnancy after being discharged from hospital. Conclusions Influenza A （H1N1） infection may aggravate the illness in pregnant patients and those in the third trimester are likely to be critically ill. Critically ill patients are characteristic of shortness of breath and hemoptysis. Most critically ill pregnant patients combined with pulmonary infection and ARDS require mechanical ventilation and a high mortality rate is seen in such patients.