重型甲型H1N1流感患者的临床研究

目的 分析重型甲型H1N1流感患者的基本特征和临床特点,为进一步防治重型甲型H1N1流感提供依据.方法 对2009年6-12月杭州市6家医院收治的36例重型甲型H1N1流感患者(重症患者27例,危重症患者9例)的临床资料进行研究分析.结果 36例患者中位年龄24.0(2.5～73.0)岁,主要表现为发热(100.0%)、咽部充血(100.0%)、咳嗽(97.2%)、乏力(75.0%)和肌痛(44.4%)等,合并肺炎27例(75.0%)、呼吸衰竭5例(13.9%).入院时,危重症患者平均发热时间、急性病生理学与长期健康评价Ⅱ(APACHEⅡ)、氧合指数、血清肌酐、血小板、肌酸激酶分别为8.5(3～17)d、(14±5)分、157(130～337)mmHg(1 mm Hg=0.133 kPa)、93(66～298)μmol/L、(113±41)×109/L、335(64～2038)U/L,而重症患者分别为6(2～13)d、(10±3)分、258(210～557)mm Hg、79(25～107)μmol/L、(164±57)× 109/L、116.0(27～451)U/L,两组比较差异均有统计学意义(t=2.104、2.790、-2.558、2.359、-2.478、2.782,P＜0.05).32例接受抗病毒治疗,13例接受糖皮质激素治疗,2例患者接受机械通气治疗.无一例患者死亡.结论 重型甲型H1N1流感患者主要见于年轻人群,主要表现为发热、呼吸道和全身症状,危重症患者多有全身多脏器损伤,APACHEⅡ评分有助于早期鉴别危重症患者.

Clinical study on patients with severe influenza A (H1N1)

Objective To describe basic characteristics, clinical features and outcomes of patients with severe irfluenza A(H1N1), and provide reference for clinical prevention and treatment. Methods 36 patients with severe influeza A(H1N1) at 6 hospitals of Hangzhou between June and December 2009 were observed, among which 27 cases were serious influenza A(H1N1) patients, 9 cases were criticalinfluenza A(H1N1) patients. Results Patients were young (median, 24.0 range, 2.5-73.0]ages).36 cases(100.0%) had fever and pharyngeal hyperemia, 35 cases (97.2%) had cough, 27 cases(75.0%) were with weak and 16 cases (44.4%)had muscle soreness. 27 cases (75.0%) had pneumonia and 5 cases(13.9%) were with respiratory failure. On admission, the median fever days,APACHE Ⅱ score, PaO2/FiO2, creatinine levels, platelet, creatine kinase levels in patients with critical influenza A (H1N1)were 8.5(3-17)days, (14±5), 157(130-337)mm Hg(1 mm Hg=0.133 kPa), 93(66-298)μmol/L, (113±41)×109/L, 335(64-2038)U/L, respectively, but in patients with serious influenza A(H1N1) were 6(2-13) days,(10±3), 258(210-557)mm Hg, 79(25-107)μmol/L, (164±57)×109/L, 116.0(27-451)U/L, respectively. There were significant differences in all parameters above between two groups (t=2.104,2.790,-2.558,2.359,-2.478,2.782, respectively, P＜0.05). 32cases received antiviral therapy with osehamivir. 13 cases received glucocorticoid.2cases received mechanical ventilation for severe acute respiratory distress syndrome and refractory hypoxemia. No patients died. Conchusions Severe illness of influenza A (H1N1) occurs mainly in young indiv iduals, the main clinical manifestations are fever, respiratory and systemic symptom. Patients with critical influenza A(H1N1) are often companied with most of multiorgans damage. APACHE Ⅱ can be used to identify critical patients in early stage.