239例甲型H1N1流感患者临床分析

目的总结239例甲型H1N1流感患者的临床特征、治疗及转归。方法回顾性分析239例甲型H1N1流感患者的临床资料。结果本组中98例（41.0%）有明确接触史。26例（10.9%）并存其他内科疾病。潜伏期中位数为2d（1～7d）。临床表现：发热（92.8%）,咳嗽（83.1%）,咽痛（47.4%）,咳痰（47.0%）,乏力（30.9%）等。根据病情划分为普通型167例（69.8%）,重症型36例（15.1%）,危重型36例（15.1%）,分组比较发现随着病情加重,患者淋巴细胞比例逐渐降低,中性粒细胞比例升高,乳酸脱氢酶水平升高,血清白蛋白水平下降,胸部X线检查异常比例增加P〈0.05。经治疗后221例（92.5%）好转出院,18例死亡。18例死亡患者均存在ARDS,其中15例合并MODS,12例（66.7%）存在基础疾病。比较生存组和死亡组发现年龄、存在基础疾病、淋巴细胞比例下降、中性粒细胞比例上升、乳酸脱氢酶水平增高、血清白蛋白水平下降、动脉血氧分压和氧合指数下降以及开始奥司他韦治疗时间延迟在两组间有显著性差异。结论ARDS为甲型H1N1流感最常见死亡原因;年龄增加、存在基础疾病是病情危重和死亡的危险因素;中性粒细胞比例升高、淋巴细胞比例降低、乳酸脱氢酶水平升高、血清白蛋白水平下降、动脉血氧分压和氧合指数下降以及抗病毒治疗延迟可提示病情重、预后差。

Clinical analysis of 2009 pandemic influenza A(H1N1) virus infection of 239 cases

Objective To investigate the clinical manifestations,treatment,and outcome of 239 patients with confirmed infection with the 2009 pandemic iniluenza A(H1N1) virus. Methods The clinical data of 239 patients who were admitted to Beijing You'an Hospital From June 1,2009,through January 7,2010,were analyzed. Results Among the 239 cases,133 males(55.6%)and 106 females(44.4%),aged 23±16(range,1 to 93 years).98 cases(41.0%)had a clear history of exposure.26 cases(10.9%)were complicated by other coexisting conditions.The median incubation period of the virus was 2 days(range,1 to 7).The most common symptoms were fever(in 92.8%of the patients),and cough(83.1%),sore throat(47.4%),sputum production(47.0%)and fatigue(30.9%),A small number of infected persons for latent infection.The course included common type 167 cases(69.8%),severe type 36 cases(15.1%),and extremely severe type 36 cases (15.1%).Comparison group was found with the sicker the patient gradually reduced the proportion of lymphocytes,the proportion of neutrophils increased,elevated levels of lactate dehydrogenase,serom albumin level decreased,chest X-ray examination abnormal increase in the proportion,the difference was statistically significant(P<0.05).221 cases(92.5%)were discharged,18(7.5%)cases died.ALL the cases of death in patients had ARDS,including 15 cases with MODS,In which 12 patients had underlying diseases.Comparison of the survival group and death group showed that age,underlying diseases,the proportion of lymphocytes decreased,the proportion of neutrophils increased,levels of lactate dehydrogenase increased,decreased serum albumin level,arterial oxygen pressure and oxygenation index decreased and the start of oseltamivir treatment of the time delay difference between the two groups was statistically significant. Conclusions Influenza A H1N1 symptoms similar to seasonal flu,from the self-limiting disease to a serious condition may require hospitalization occurs,ARDS is the most common cause of death;increasing age,underlying diseases is in critical condition and death risk factors;in the increased the proportion of neutrophils,lymphocytes ratio is lowered,elevated levels of lactate dehydrogenase,serum albumin level decreased arterial oxygen pressure and oxygenation index decreased and anti-viral treatment delay may prompt severe illness and the prognosis is poor;early Identification of risk factors for aggressive treatment to help improve the prognosis.