成功救治甲型H1N1流行性感冒危重症一例

患者女,28岁,因咳嗽、咳痰、发热5d入院。患者于2009年10月27日无诱因出现咳嗽,咳少量黄黏痰且难以咳出,伴周身肌肉酸痛,发热（达39．5℃）,无畏寒、寒战,有恶心、呕吐少许胃内容物,无腹痛、腹泻。10月28日于社区医院静脉滴注氨曲南3d,上述症状无好转,     

甲型H1N1流行性感冒临床特征分析

对3499例甲型H1N1流行性感冒病例进行流行病学调查和咽拭子采样,用实时荧光定量聚合酶链反应方法检测患者甲型H1N1流行性感冒病毒核酸,分析患者临床特点和排毒时间.结果 显示,有13例（0.37%）为隐性感染,症状中出现最多见为发热（86.77%）,平均咽拭子转阴时间为发病后6 d,未发现与咽拭子转阴时间的临床相关因素。     

甲型H1N1流行性感冒普通型与重型患者临床特征分析

采用描述性流行病学方法对确诊的150例普通甲型流行性感冒和38例重型甲型流行性感冒患者的临床资料进行回顾性分析.普通型患者主要表现为季节性流感样症状,并发症少,重型患者的症状则以持续高热、咳血痰、气促、呼吸困难为主,并可出现呼吸衰竭、急性呼吸窘迫综合征等并发症.重型患者肥胖及存在基础疾病的比率明显高于普通型,差异具有统计学意义（P＜0.05）,肥胖及有基础疾病者是重型甲型流行性感冒的高危人群.普通型患者均治愈出院,病程5～11 d;重型中34例症状好转出院,4例死亡,病死率10.5%。     

早期无创正压通气救治重症甲型H1N1流行性感冒一例

患者男,50岁。2009年11月24日,因“咳嗽4d伴发热、痰中带血1d”就诊。患者既往体健。入院前4d因受凉出现咳嗽、无痰、全身酸痛、乏力,当地社区服务中心给予“头孢他啶”治疗,症状无减轻,     

甲型H1N1流行性感冒聚集性爆发后社区和定点医院治疗效果调查

分析5所高校甲型H1N1流行性感冒（H1N1流感）聚集性爆发后在社区和定点医院的治疗效果。社区医院确诊病例28例,疑似病例182例,密切接触者136例;定点医院接受治疗的56例。在社区和定点医院治疗的疗效差异无统计学意义（P〉0．05）。对疑似病例和密切接触者社区解除隔离后随访7d,无新发病例。说明甲型H1N1流感可防、可控、可治,轻症病例可在社区医疗机构治疗。     

139例甲型H1N1流感患者诊治体会

2009年3月,墨西哥暴发＂人感染猪流感＂疫情,并迅速在全球范围内蔓延。世界卫生组织（WHO）初始将此型流感称为＂人感染猪流感＂,后将其更名为＂甲型H1N1流感＂。     

甲型H1N1流感患者的护理体会

自我市发现第1例甲型H1N1流感以来，我院采取紧急预防，控制措施，全面启动落实医疗救治应急管理体系，做到早发现、早报告、早隔离、早治疗，自2009年5～11月，共收治甲型H1N1确诊患者8例。现将护理体会总结如下。     

甲型H1N1流感危重症15例临床分析

目的:通过甲型H1N1流感危重症病例资料的回顾性研究,总结甲型H1N1流感危重症患者的临床、实验室检查、影像学、治疗及转归等特点,以指导临床实践。方法:回顾性分析确诊为甲型H1N1流感危重症共15例,对其流行病学、临床表现、实验室检查、影像学表现、治疗及转归等进行统计学处理和综合分析。结果:15例患者中男4例,女11例,平均发病年龄(35.20±18.88)岁,其中8例为孕产妇,4例有慢性基础疾病。疾病加重中位时间为3 d,平均时间(3.13±1.51)d。临床症状无特征性,发热、咳嗽、咯痰、纳差、呼吸困难、气促是主要症状。患者首次血常规检测白细胞总数正常或减低(14例,93.3%)。所有患者前白蛋白均降低,50%以上的患者总蛋白、白蛋白降低。发病初期8例乳酸脱氢酶(LDH)增高,5例LDH增高大于正常值上限2倍且均需呼吸机治疗。胸部CT主要表现为双肺多发实变影及磨玻璃影,以双下肺和胸膜下分布为主。治愈14例,死亡1例,出院4周后随访10例患者胸部CT示炎性反应基本吸收。结论:孕产妇及有基础疾病者易为甲型H1N1流感危重症,疾病进展迅速,疾病加重拐点可能为发病第3天;大多数患者血常规白细胞总数正常或减低,所有患者前白蛋白均减低;发病初期LDH升高大于正常上限2倍以上者病情更加严重;绝大部分患者可治愈,预后良好。     

新型甲型H1N1流感84例临床观察及治疗转归

目的 探讨新型甲型H1N1流感的临床特点和治疗,以期提高对新型甲型H1N1流感的认识.方法 对该院收治的84例新型甲型H1N1流感患者的临床资料进行统计学分析,并分别对输入性和两组聚集性病例进行对比分析,找出甲流患者的发病特点和最佳治疗方法 .结果 84例均为轻症患者,发热83例(98.8%),咳嗽59例(70.2%),咯痰43例(51.2%),咽痛40例(47.6%),流涕30例(35.7%),聚集性病例症状明显.出现白细胞减低24例(28.6%),3组比较差异有显著性.输入性病例(Ⅰ)组热程(3.00±0.97)d,咳嗽持续时间(4.50±1.31)d;聚集性病例(Ⅱ)组热程(3.26±0.80)d,咳嗽持续时间(5.26±1.68)d.聚集性病例(Ⅲ)组热程(3.36±2.08)d,咳嗽持续时间(4.92±1.54)d.3组之间比较差异无显著性.鼻咽拭子甲型H1N1流感病毒核酸转阴时间Ⅰ组为(7.1±1.68)d,Ⅱ组为(8.47±1.67)d,Ⅲ组为(8.77±0.61)d.应用奥斯他韦组和中药组在甲型H1N1流感病毒核酸转阴时间上无显著差异.男女之间在甲型H1N1流感病毒核酸转阴时间上也无显著差异.结论 轻症甲流患者临床表现无特殊性,可引起白细胞下降.治疗上应用中药就可收到较好疗效.     

甲型H1N1流感孕妇35例临床特征分析

目的分析甲型H1N1流感孕妇的临床特征。方法回顾性分析35例甲型H1N1流感孕妇的临床资料,并与同期因上呼吸道感染就诊的普通流感孕妇100例的临床资料进行对比分析。结果与普通流感孕妇相比,甲型H1N1流感孕妇发热、咳嗽和咽痛的发生率均明显高（均〈0.05）,流涕、鼻塞、咳痰、头痛、全身酸痛乏力、呕吐及腹泻等其他症状的发生率差异均无统计学意义（均〉0.05）,血常规各项指标、超敏C反应蛋白水平检测结果差异均无统计学意义（均〉0.05）。结论甲型H1N1流感孕妇临床症状略多于普通流感孕妇,血常规及超敏C反应蛋白水平和普通流感孕妇差异不明显。     

Hospitalized patients with novel influenza A (H1N1) virus infection: Shanghai, June–July 2009

Background From late May 2009, sporadic imported cases of novel influenza A （HIN1） were continuously confirmed in Shanghai, but there were few reports on its clinical presentation in China. The aim of the study was to investigate the demographic and clinical features of the laboratory-confirmed cases and the treatment with oseltamivir. Method We performed a retrospective study in the Shanghai Public Health Clinical Center （SHAPHC）, reviewing the medical records of the laboratory-confirmed patients derived from June 10 to July 20, 2009. Results A total of 156 cases were enrolled, of whom 152 had a history of recent travel. The mean age was 22.6 years and 89 cases （57.1%） were males. The most common symptoms were fever, cough, and sore throat, with children more likely to run a temperature above 38.5℃ than adults. The mean leucocyte count was 5.4×10^9/L, the mean neutrophil count 3.2×10^9/L and the mean lymphocyte count 1.4×10^9/L. Other findings included a normal range or elevated level of C-reactive protein （CRP） and glutamic-pyruvic transaminase and a normal or decreased level of prealbumin; the levels of prealbumin and CRP were significantly lower in the children than in the adults. Fifty-two patients had abnormal chest CT results, with small unilateral or bilateral pulmonary infiltrates, axillary and mediastinal lymphadenopathy and local pleural thickening, while no cases showed symptoms of hypoxia. All the patients received oseltamivir and recovered without complications, but the duration of fever and virus shedding were significantly longer in the children than in the adults. Conclusions Travel-related circulation may be an important reason for the H1N1 epidemic in the non-epidemic areas, and the virus caused mild respiratory symptoms. The infection in children was more severe in terms of prealbumin levels, temperature, the duration of fever and virus shedding. Oseltamivir was effective for H1N1, but more effective in the adults than in the children.     

Sixty-two severe and critical patients with 2009 influenza A (H1N1) in Shanghai, China

Background  Pandemic influenza A (H1N1) emerged rapidly in China in May 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A (H1N1) disproportionately affects younger ages and causes generally mild disease. To characterize disease progress, comorbidities, and treatment outcomes among consecutive severe and critically ill patients in a hospital served as a reference center for the care of patients with H1N1 in Shanghai, China.

Methods  A retrospective study on 62 severe and critically ill patients with 2009 influenza A (H1N1) was conducted in Shanghai Public Health Clinical Center. Demographic data, symptoms, comorbidities, disease progression, treatments, and clinical outcomes were collected for analysis.

Results  Sixty-two severe or critically ill patients were admitted to the hospital with confirmed 2009 influenza A (H1N1) infection. The median age of the study cohort was 40 years old with a range from 18 years to 75 years, and 67.7% were males. All patients presented with fever and respiratory symptoms. At presentation, 34 patients (54.8%) had comorbidities such as smoking (29.0%), hypertension (29.0%) and hepatitis B virus infection (9.7%). The median time from symptom onset to hospital admission was 6 days (interquartile-range 3–14 days) and 23 critically ill patients were admitted to Intensive Care Unit after admission. All the patients received neuraminidase inhibitors (oseltaminir), while 60 patients (96.7%) were treated with antibiotics, and 39 (62.9%) with corticosteroids. Twenty-three critical cases received noninvasive mechanical ventilation on the first day of admission, and 3 of them ultimately required invasive ventilation. Four death reports (6.5%) were filed within the first 14 days from the onset of critical illness with the primary causes of severe acute respiratory distress syndrome, hypoxemia, or complications, secondary infection and sepsis, pyopneumothorax and stroke.

Conclusions  Severe illness from 2009 influenza A (H1N1) infection in Shanghai occurred among young individuals. Critical cases were associated with severe hypoxemia, multisystem organ failure, and a requirement for mechanical ventilation. Most patients had a good prognosis.

     

13例甲型H1N1流感危重症病例临床资料回顾性分析

目的探讨甲型H1N1流感危重症患者的临床特征及部分实验室检查的特点。方法回顾性分析13例甲型H1N1流感危重症患者临床资料。结果①13例中女性11例,孕妇7例,多以发热、咳喘等呼吸道症状就诊。②13例中有11例发生轻度肝功能损伤,其中7例孕妇均发生肝功能的损伤,主要表现为谷丙转氨酶（ALT）、谷草转氨酶（AST）不同程度的增高,肝功能损伤多见于病程的第1周;12例出现乳酸脱氢酶（LDH）的升高;8例出现肌酸激酶（CK）的升高。③13例患者最终死亡2例,均为女性,入院时均有ALT、AST的轻度升高,而LDH和CK明显升高,均于发生少尿后48 h内死亡。结论女性尤其是孕妇感染甲流H1N1容易发展为危重症;多数危重症甲型H1N1流感患者伴有轻度肝功能损伤;危重症甲型H1N1流感患者伴有LDH及CK明显升高者预后不良。     

重症甲型H1N1流感并肺炎的临床和影像学特点分析并文献复习(附39例病例报道)

目的 探寻新型重症甲型H1N1流感的发病规律,积累诊治经验.方法 回顾性分析中南大学湘雅二医院2009年甲型H1N1流感病房收治的诊断为重症甲型H1N1流感并肺炎的39例患者的临床和影像学特点,并结合文献复习.结果 发病年龄2岁11月～57岁.既往有基础疾病的患者11例(28.2％),肥胖症1例(2 6％),妊娠4例(10.3％).起病均有流感样症状(100％),10( 25.6％)例出现活动后气促.血气分析提示4例为I型呼衰,3例为低氧血症.胸部影像学表现主要为毛玻璃样模糊阴影的背景下,有局部散在、片状的高密度影,既有急性肺间质改变的表现,又有局灶肺实变的表现,但几乎未见典型的大叶性肺炎影像学改变.39例均为确诊病例.入院后立即给予奥司他韦抗病毒治疗,37例病例痊愈,2例患者死亡.结论 年龄较大(大于60岁)的人群中发生重症甲流的病例很少,孕妇在此次甲型H1N1流感病毒流行中感染后较易发展为重症;重症主要并发肺炎,以双下肺野分布的磨玻璃样模糊阴影为其典型的影像学表现;发病时间超过48小时仍不应放弃奥司他韦抗病毒治疗.     

Potential infections of H5N1 and H9N2 avian influenza do exist in Guangdong populations of China

Background Southeast China is one of the sites of influenza origin. During 2003-2004, nine avian influenza outbreaks took place in Guangdong Province. But no human case was reported. To examine the status of potential human infection by human influenza （H1N1, H3N2） and avian influenza （H5N1, H7N7, H9N2） in the avian influenza epidemic area of Guangdong Province, China, we conducted a seroepidemiologic survey in the people of this area from April to June of 2004.
Methods Three out of 9 H5N1 avian influenza affected poultry areas in Guangdong were randomly selected, and the population living within 3 kilometers of the affected poultries were chosen as the survey subjects. One thousand two hundred and fourteen people were selected from 3 villages at random. Human and avian influenza antibody titers were determined by hemagglutination-inhibition （HI） test and microneutralization test （MNT）.
Results The positive rate of antibody to H5N1 was 3.03% in the occupational exposure group and 2.34% in general citizens group; that of H9N2 was 9.52% in the occupational exposure group and 3.76% in the general citizens group. Moreover one case in the occupational exposure group was positive for H7N7. One year later, all previously positive cases had become negative except for one H5N1-positive case.
Conclusion The observations imply that H5N1 and H9N2 avian influenza silent infections exist in Guangdong populations.     

惠州市2009年6～12月流感哨点监测结果分析

目的通过流感监测为评估本地流感疫情的严重性、预测流行趋势、评估防控策略和措施的有效性提供依据。方法设立流感样病例监测哨点医院,对符合流感样病例定义的病例收集相关信息,采集咽拭子标本,采用实时荧光定量PCR对标本进行流感病毒核酸检测,并通过“中国流感监测信息系统”录入相关信息,使用SPSS分析软件进行统计分析。结果 2009年惠州市甲型H1N1流感哨点监测流感病毒核酸检测阳性率为50.40%,男性阳性率为50.29%,女性阳性率为50.54%;6～8月以甲（A）季H3亚型为优势毒株,9～12月以甲（A）H1N1亚型为优势毒株;各型（或亚型）流感病毒核酸检测阳性率性别间差异不显著;不同年龄组甲（A）H1N1亚型流感病毒核酸检测11-20岁年龄组的阳性率明显高于其他年龄组,61岁以上年龄组阳性率明显较低,其他各亚型不同年龄组间比较差异不显著。结论惠州市流感病毒以甲（A）型为主,加强学校流感样病例监测,对控制疫情的发生、发展起到至关重要的作用。     

金刚烷胺修饰物抗禽流感病毒的作用机制

目的：初步探讨金刚烷胺修饰物（NAM）抗禽流感病毒的作用机制,为抗禽流感病毒新药NAM的开发提供实验依据。方法：对狗肾细胞（MDCK）进行体外培养,分为正常对照组,病毒对照组和受试物组。①采用细胞病变法结合MTT法检测NAM对禽流感病毒（H5N1）的抑制作用,受试物组分为先加入NAM后感染病毒、先感染病毒后加入NAM和感染病毒的同时加入NAM,观察3种方式NAM对禽流感病毒的半数抑制浓度(IC50)和治疗指数(TI);②采用神经氨酸酶抑制实验检测NAM对神经氨酸酶的活性影响。结果：① 3种不同的实验方式NAM剂量对数与细胞保护率均呈正相关关系（r 分别为0.95、0.95和0.99,P均<0.05）,且NAM与保护率存在量效依赖关系。先加入NAM后感染病毒,NAM的IC50为15.32 mg·L-1,TI为103.31;先感染病毒后加入NAM,NAM的IC50为30.78 mg·L-1,TI为28.10;感染病毒的同时加入NAM,NAM的IC50为203.92 mg·L^-1,TI为4.24。②NAM具有一定的流感病毒神经氨酸酶抑制活性,其IC50为87.36 mg·L^-1。结论：NAM对穿入细胞后的禽流感病毒有较好的抑制作用,同时干扰病毒吸附和侵入细胞的脱壳过程也有一定的作用,能够在一定程度上抑制病毒的神经氨酸酶活性。