四川省135例重症甲型H1N1流感病例的临床分析

目的通过分析来自四川省内12个市州的135例重症(含危重症)甲型H1N1流感病例的临床资料,探讨重症病例的临床特征及预后相关因素。方法按照卫生部《甲型H1N1流感诊疗方案(2009年试行版第三版)》的诊断标准,纳入2009年9月12日至2009年12月14日期间,来自四川省内12个市州确诊的重症及危重症甲型H1N1流感病例135例,分析患者的一般情况、并发症、接受治疗的情况以及预后,用多元逐步Logistic回归分析患者死亡相关影响因素。结果135例患者中男性86例,女性49例;平均年龄(28.2±19.3)岁,19～45岁占47.4%;96例患者(71.1%)有发热症状,51例患者(37.8%)有基础疾病;发生率最高的三类并发症依次为肺部受累(71.1%)、肝功能异常(27.4%)和心脏受累(24.4%);130例患者(96.3%)给予奥司他韦抗病毒治疗,26例患者(19.3%)接受机械通气治疗;12例患者死亡,与存活者相比,死亡病例的平均年龄较高,入院时平均动脉压较低,功能异常的脏器数量较多,心脏及神经系统异常比例较高,未进行抗病毒治疗的比例较高,需进行机械通气治疗的比例较高(P均0.05)。多元逐步Logistic回归分析显示入院时的平均动脉压和是否需要接受机械通气治疗为患者死亡的独立预测因素(P0.05),OR值分别为0.86(95%CI为0.002～0.936)和13.86(95%CI为1.146～16.583)。结论重症及危重症甲型H1N1流感患者中男性多于女性,以19～45岁年龄段的患者比例最高;发生率最高的三类并发症依次为肺部受累、肝功能异常和心脏受累;病死率为8.9%,与存活者相比,死亡病例的平均年龄较高,入院时平均动脉压较低,功能异常的脏器数量较多,心脏及神经系统异常的比例较高,未进行抗病毒治疗的比例较高,进行了机械通气治疗的比例较高,差异均有统计学意义。多因素分析显示入院时的平均动脉压较低和需要接受机械通气治疗为患者死亡的独立预测因素。

The Clinical Characteristics of Patients with Severe Pandemic H1N1 Influenza in Sichuan,China

Objective To explore the clinical characteristics of patients with severe pandemic H1N1 Influenza in Sichuan and risk factors related to patients＇ prognosis. Methods We observed 135 severe patients who came to hospitals for pandemic H1N1 Influenza from 12 cities in Sichuan, China, between September 12, 2009 to December 14, 2009, and described their baseline characteristics, treatment,and outcomes. A stepwise multiple Logistic-regression analysis was used to evaluate the independent predictors of death. Results Of the 135 patients we studied, 86 patients were male. The average age was （28.2 ± 19. 3） years old, while patients between 19 to 45 years of age accounted for 47.4%. 96 patients （71.1% ） presented with fever. 51 patients （37. 8% ） had comorbid conditions. The most frequent organ dysfunction was seen in lung （ 71.1% ）, liver （ 27.4% ） and cardia （ 24.4% ） ; 130 patients （ 96. 3% ） had received oseltamivir, 26 patients （ 19. 3% ） required mechanical ventilation. 12 of the 135 patients died. Compared with the survivors, patients who died were more likely to have a higher age, lower average blood pressure when admitted, more organ dysfunction, and more likely to have cardia or nervous system dysfunction. The nonsurvivors also seemed to have less opportunity to be exposed to neuraminidase inhibitors, and have more demand for mechanical ventilation. The P value were all under 0. 05. The multiple Logistic-regression analysis showed the independent predictors of death were the average blood pressure when admitted and the demand for mechanical ventilation . The P value were both under 0.05. The OR value was 0. 86（95% CI 0. 002-0. 936） and 13.86 （95% CI 1. 146-16. 583 ）, respectively. Conclusions For these severe patients with pandemic H1N1 Influenza we study, the male patients are more than female. Most patients are between 19 to 45 years of age. The most frequent organ dysfunction is seen in lung, liver and cardia. The mortality of these patients is 8.9%. Compared with the survivors, patients who died were more likely to have a higher age, lower average blood pressure when admitted, more organ dysfunction, and more likely to have cardia or nervous system dysfunction. The nonsurvivors also seemed to have less opportunity to be exposed to neuraminidase inhibitors, and more demand for mechanical ventilation. The multiple Logistic- regression analysis showed the independent predictors of death are the average blood pressure and the demand for mechanical ventilation. The OR value is 0. 86 （ 95% CI 0. 002-0. 936 ） and 13.86 （ 95% CI 1. 146-16. 583） respectively.