一例甲型H1N1流感危重症患者的救治

<正>甲型H1N1流感自2009年3月墨西哥报告首例以来,迅速蔓延至全球。目前,甲型H1N1流感在我国呈散发流行。危重症患者病情发展迅速,重者因呼吸衰竭、多器官功能障碍而死亡。本院是四川省甲型H1N1流感的定点收治医院,本文通过对甲型H1N1流感危重症进行病例报告,总结临床救治经验,报道如下。一、病例介绍1.患者,男,59岁,因"发热、咳嗽、咯痰10 d,呼吸困难4 d"由外院转入。既往有"高血压病"病史     

甲型H1N1流感并发双侧肺炎1例

患者女,41岁,因发热、咳嗽、咽痛4d于2009年7月11日收治入院。患者2009年7月2日至菲律宾旅游,2009年7月7日回国。2009年7月8日起出现持续高热（39．7～40．0℃）、干咳。查血常规示WBC3．1×10^9／L,中性粒细胞0．60,淋巴细胞0．23,单核细胞0．11;血生化检查示ALT180U／L,AST155U／L,谷氨酸转氨酶129U／L,血钾2．9mmol／L;肾功能正常;胸部x线示右中、下肺片状阴影;     

产褥期重症甲型H1N1流感一例的救治及护理

重症甲型H1N1流感是甲型H1N1流感病毒侵袭肺脏而产生的一种急性呼吸道传染性疾病,患者表现为持续高热、剧烈咳嗽、痰多、胸闷、口唇发紫,甚至出现呼吸衰竭及多器官功能损伤,导致死亡。孕产妇处于低免疫状态,如感染甲型H1N1流感病毒,容易发展成为肺炎型或重症甲型H1N1流感。     

甲型H1N1流感7例

2009年6月11-26日,湖北省宜昌市第三人民医院感染科共收治甲型H1N1流感患者7例,其中男6例,女1例。所有患者均来自美国同一所中学,其中1例为老师,年龄54岁,其余6例均为学生。7例患者中出现发热6例,体温多在38℃左右,驰张热,一般持续3d左右,咽痛2例,咳嗽3例,肌痛1例,鼻塞2例,咽部红肿7例,扁桃体肿大5例。     

甲型H1N1流感并发肺炎六例影像学分析

2009年3月起暴发的甲型H1N1流感目前正处于大流行时期,其主要临床表现有发热、头痛、肌痛、关节痛及上呼吸道症状等,严重的可发生肺损伤或急性呼吸窘迫综合征等严重并发症,部分病例甚至因多器官功能衰竭而死亡。影像学检查有助于肺部损害的客观评估及并发症的早期诊断,笔者对宁波大学医学院附属医院的6例甲型H1N1流感并发肺炎患者的影像学资料进行了回顾性分析。     

浙江省首次应用康复期血浆成功救治甲型H1N1流感危重症患者

2009年3月,在墨西哥暴发的人感染猪流感是一种新型的甲型H1N1流感,人群对此普遍易感.虽然大部分患者病情较轻,但一些高危人群,如妊娠期妇女以及伴有慢性疾病、免疫功能低下等人群感染后,较易发展为重症或危重症患者,且病死率高[1].     

双重滤过血浆置换抢救吉兰-巴雷综合征一例

体液免疫在吉兰-巴雷综合征(Guillain-Barré syndrome,GBS)中起着重要作用[1].肾上腺皮质激素无法阻止其病情进展,但是清除患者体内的致病物质可以达到治疗目的[2].我们试用双重滤过血浆置换(double-filtration plasmapheresis,DFPP)抢救吉兰.巴雷综合征1例,效果良好,报道如下.     

甲型H1N1流感并发肺部感染七例临床分析

甲型H_1N_1流感是一种新型流感病毒引起的急性呼吸道传染病.病毒表面有2种蛋白质：红细胞凝集素（H）和神经氨酸酶（N）.研究发现该病毒含有猪流感、禽流感和人流感3种流感病毒的核糖核酸基因片段~（[1]）.此病毒传染性大,毒力强,人群普遍易感.2009年3月墨西哥、美国相继暴发甲型H_1N_1流感,疫情在全球迅速蔓延.     

体外膜肺氧合辅助救治危重症甲型H1N1流感孕妇一例

患者女,28岁,妊娠25周,因发热、咳嗽4d,于2013年1月11日入院.患者1月7日无明显诱因出现畏寒、发热,体温38.3℃,伴干咳、流涕、咽痛.在当地医院门诊就诊,拟诊"上呼吸道感染",给予头孢曲松抗感染治疗1d,效果欠佳;口服中成药治疗3d,仍反复发热,体温升至39.5℃,遂转来我院.既往体健,无药物过敏史.入院时查体:体温38.5℃,脉搏108次/min,呼吸21次/min,血压94/54 mm Hg(1mm Hg =0.133 kPa),急性面容,双肺呼吸音粗,右下肺可闻及湿性啰音,左肺未闻及干湿性啰音.入院诊断:社区获得性肺炎,宫内妊娠25周.查血常规:白细胞5.0×109/L,中性粒细胞0.83,血红蛋白86 g/L,血小板185×109/L.产科彩超:宫内妊娠相当于25周.患者因妊娠不同意拍胸片,予吸氧、头孢美唑抗感染及对症支持治疗.     

甲型H1N1流感合并侵袭性肺曲霉病的诊治

1临床资料 患者男，22岁，因咳嗽、咳痰、发热1周，咯血、气促1d于2009年11月22日入院。患者既往体健，2009年11月15日无明显诱因出现咳嗽，咳白色黏液痰，伴发热，无胸痛、气促、盗汗、乏力等。11月21日凌晨4时突然咯血约40mL，于当日8时到外院就诊，并再次咯血约200mL，摄片检查胸片示两上中下肺淡薄模糊影，右中肺融合成团片状密集影，诊断为肺结核转诊我院。     

Microcirculatory abnormalities in patients with severe influenza A (H1N1) infection

Purpose

This study was designed to evaluate the degree of microcirculatory abnormalities in patients with severe influenza A (H1N1) infection.

Methods

We assessed the sublingual microcirculation in seven consecutive patients with acute lung injury related to influenza A (H1N1) infection. The evaluation was carried out using sidestream dark field (SDF) imaging within the first 96 hr after the patients were admitted to the intensive care unit. Thenar oxygen saturation (StO₂) was also measured with near-infrared spectroscopy (NIRS) during a vascular occlusion test. In addition, the Lung Injury Score (LIS) and the APACHE II and SOFA scores were recorded.

Results

All patients received invasive mechanical ventilation and at least one of the following adjuvant therapies: inhaled nitric oxide (n = 4), extracorporeal membrane oxygenation (n = 1), prone position (n = 4), recruitment maneuver (n = 3), and hydrocortisone 50 mg·hr^?6 (n = 6). The median time from admission to microcirculatory assessment was 21 hr. Three patients had bacterial superinfection. The median LIS and PaO₂/F _i O₂ were 2.5 (2.25-3.25) and 178 (158-212), respectively. Three subjects were treated with norepinephrine. During a vascular occlusion test, the microcirculation was moderately to severely compromised with a NIRS ascending slope of 2.39%·sec^?1 (1.75-2.67%·sec^?1), 66% (60-86%) of perfused small vessels in the sublingual microcirculation, and a microvascular flow index of 1.9 (1.3-2.6). The degree of microcirculatory abnormalities detected by the NIRS and SDF imaging techniques was correlated with the severity of the disease, as reflected by the SOFA and APACHE II scores.

Conclusions

The microcirculation as assessed by SDF imaging and NIRS techniques was compromised in patients with acute respiratory distress syndrome (ARDS) and influenza A (H1N1) infection.     

Pandemic H1N1 influenza A viral infection complicated by atypical hemolytic uremic syndrome and diffuse alveolar hemorrhage

We report here on a case of a 27-year-old man with atypical hemolytic uremic syndrome and diffuse alveolar hemorrhage associated with influenza A H1N1 infection. Treatment with oseltamivir, plasma exchange and hemodiafiltration for the hemolytic uremic syndrome and meticulous supportive care with steroid pulse therapy for the pulmonary alveolar hemorrhage was successful in this case. We discuss the relationship between hemolytic uremic syndrome and influenza A and the underlying immunologic factors that should be tested in a patient with atypical hemolytic uremic syndrome. We also discuss using steroid therapy for patients with H1N1-related diffuse alveolar hemorrhage.     

深圳市首例甲型H1N1流感危重症孕产妇临床报道

目的探索孕产妇甲型H1N1流感危重型病例的临床特点及诊治经验。方法深圳市首例甲型H1N1流感危重症孕产妇患者,应用奥司他韦和扎那米韦联合抗病毒治疗,早期机械辅助通气、抗菌药物、糖皮质激素、对症支持等综合治疗。采用荧光定量RT-PCR评价抗病毒治疗效果,动态放射学检查、血气分析、血常规和生化检查监测病情变化。结果该孕产妇以高热、咳嗽、呼吸困难为主要症状,3d后进展为重症肺炎,合并急性呼吸窘迫综合征（ARDS）。联合抗病毒治疗后,患者体内的病毒在短期内得到有效控制和清除;抗菌药物有效控制细菌感染;机械通气、激素及其他对症支持治疗有效控制了ARDS。结论孕产妇甲型H1N1流感病情重、进展快,易合并ARDS为其主要临床特征。早期迅速清除病毒、及时正确的机械通气、选择有效抗菌药物控制继发细菌感染是治疗成功的关键。激素类药物的使用值得进一步探索。