Evaluation of the organ function in children with severe human swine influenza A (H1N1) infection

目的 研究重症H1N1流感病毒感染小儿器官系统功能衰竭情况.方法 PCR检测H1N1流感病毒RNA阳性重症患者32例,按小儿多器官功能衰竭诊断标准对各器官系统进行评估.结果 (1)重症H1N1流感病毒感染小儿呼吸系统与中枢神经系统功能衰竭发生机率最高,分别为46.88％与12.5％；(2)其他器官系统功能衰竭未见单独出现,多与呼吸与神经系统异常伴发；(3)急性坏死性脑病是重症H1N1流感病毒感染小儿死亡的重要原因.结论 重症H1N1流感病毒感染小儿呼吸系统与神经系统功能衰竭发生机率高,值得临床医生注意.     

重症与危重症甲型H1N1流感护理体会

甲型H1N1流感(简称甲流)是一种由新的甲型H1N1流感病毒引起的急性呼吸道传染病,通过近距离飞沫和接触传播,具有较强的传染性,人群普遍易感[1] .重症与危重症甲流患者往往均合并有严重的肺部感染,继而出现呼吸衰竭、多脏器功能不全或衰竭,病情严重者可导致死亡.我院负压病房(重症监护病房)于2009年4月至2011年2月共收治42例危、重症甲型H1N1流感患者,经过积极正确的治疗和护理干预40例治愈出院,2例死亡.     

新型甲型H1N1流感监测体系的建立与应用分析

目的了解甲型H1N1流感病毒病原学变迁与变异特征,分析重症病例危险因素,为科学防控提供依据。方法建立甲型H1N1流感监测体系,定期收集生物学标本实施甲型H1N1流感病毒核酸检测、病毒分离与测序分析;利用Logistics回归模型分析重症病例发生死亡的危险因素。结果 2009-2013年甲型H1N1流感病毒分离阳性率分别为13.83%(481/3 479)、4.46%(136/3 047)、9.13%(233/2 550)、0(0/2 643)和4.68%(159/3 400)。共完成18株毒株测序,2009-2010年的9株毒株位于第一主干枝,2011年的4株甲型H1N1流感病毒毒株聚集成第二主干枝,2013年的5株毒株中有4株位于第三主干枝。从2011年起,甲型H1N1流感毒株与疫苗株相距较远;共报告重症病例77例,其中40例(57.14%)有基础疾患,死亡16例。多因素Logistic分析显示慢性肺部疾病进入回归方程,OR=7.72(95%CI:1.97~30.23)。结论甲型H1N1流感监测系统在广州运行良好。甲型H1N1流感已经取代了A(H1N1)流感呈现季节性流行,慢性肺部基础疾患是甲型H1N1流感重症病例发生死亡的危险因素。2011年起,甲流疫苗与广州人群的流行毒株匹配较差,应持续开展甲流监测,密切关注毒株变化特征。     

3例重症甲型H1N1流感产妇的护理体会

总结3例重症甲型H1N1流感产妇的护理经验。重点介绍消毒隔离,呼吸系统功能监护,各种导管监护,心血管系统、神经系统、内分泌系统的监测,维持水电解质平衡,营养支持及心理护理等方面的护理经验。3例患者均治愈出院。     

揭秘甲型H1N1流感病毒

<正>甲型H1N1流感是一种由A型猪流感病毒引起的猪呼吸系统疾病,该病毒可在猪群中造成流感暴发。通常情况下人类很少感染甲型H1N1流感病毒。近年在美国等地也出现过人感染甲型H1N1流感病例,患者大多为与病猪有过直接接触的人。人可能通过接触受感染的生猪或接触被甲型H1N1流感病毒感染的环境,或通过与感染甲型H1N1流感病毒的人发生接触。人感染甲型     

中药对H1N1流感病毒致急性肺损伤影响机制的研究进展

H1N1流感病毒是最易发生变异的流感病毒,人感染H1N1流感病毒后的临床症状主要表现为高热、咳嗽、肌肉酸痛,病情严重者快速进展为急性肺损伤(Acute lung injury, ALI),ALI是H1N1流感病毒感染后致死的主要因素。H1N1流感病毒致ALI机制尚未有明确定论,目前国内外公认的机制主要有炎症反应、细胞因子表达,免疫调控机制,凝血/纤溶系统失衡,细胞凋亡、自噬及焦亡等。近年来,部分中药被证实可有效缓解H1N1流感病毒致ALI患者持续性高热、进行性低氧症等症状,但中药治疗H1N1流感病毒致ALI作用机制尚不明确,明确中药对H1N1流感病毒致ALI影响机制后筛选安全、有效的中药有望成为H1N1流感病毒致ALI治疗的新手段。     

甲型H1N1流感病毒神经氨酸酶基因遗传进化分析

【目的】 了解季节性H1N1流感病毒与2009年新型H1N1流感病毒神经氨酸酶(NA)基因的遗传进化关系,探讨甲型H1N1流感病毒的遗传变异规律&#65377;【方法】 分别从2006年和2009年流感病人标本中分离并鉴定出季节性HIN1流感病毒和新型H1N1流感病毒,用RT-PCR技术扩增了病毒NA基因全序列,并对其分子进化和重要功能位点的遗传变异进行了分析&#65377; 【结果】 2009年新型H1N1流感病毒与2006年季节性HIN1流感病毒比较,NA基因的同源性较低(77.9% ~ 78.8 %),与世界各地不同年代代表株及WHO推荐的1979 ~ 2010年季节性流感疫苗株比较,NA基因的同源性也较低(78.1% ~ 79.3%),但与WHO推荐的2009年新型H1N1流感疫苗株比较同源性则高达99%以上;系统进化分析结果表明,2009年新型H1N1流感病毒NA基因与欧亚猪流感病毒株A/swine/Belgium/1/1983的亲缘关系最近;并发现自2005年以来季节性H1N1流感病毒NA基因的某些抗原位点和神经氨酸酶活性位点已发生了变异&#65377;【结论】 2009年新型H1N1流感病毒NA基因可能来源于欧亚猪流感病毒;接种季节性流感疫苗不能对本次流行的新型流感产生有效的免疫保护作用;季节性H1N1流感病毒在流行过程中NA基因已发生了一定的变异,有必要持续跟踪和监测病毒的变异情况&#65377;     

广州市甲型H1N1流感暴发疫点与监测人群病毒抗体检测

目的通过分析广州市甲型H1N1流感暴发疫点与监测人群病毒的抗体水平,了解甲型H1N1流感的流行趋势,为预防甲型H1N1流感疫情提供科学依据。方法应用红细胞血凝抑制(HI)方法检测流感甲型H1N1抗体,对比分析1570名疫区学生与1326名监测人群血清标本H1N1流感病毒的抗体水平。结果疫区学生甲型H1N1流感病毒感染率、流感罹患率分别为32.17%、22.23%,明显高于市区监测人群的22.62%、15.38%(P=0.000,P=0.000)。疫点学生与市区监测人群甲型H1N1流感隐性感染率分别为9.94%、7.24%,差异有统计学意义(P=0.012)。在已感染甲型H1N1流感病毒的疫点学生和市区监测人群中,甲型H1N1流感隐性感染率(30.89%、32.00%)差异无统计学意义(P=0.754)。疫点人群显性感染者的抗体滴度明显高于隐性感染者(t=4.701,P=0.000),监测人群中显性感染与隐性感染者的抗体滴度无显著差异(t=0.248,P=0.804)。结论疫点学生甲型H1N1流感隐性感染率明显高于监测人群。提示隐性感染人群具有潜在的传染力,应加强隐性感染者的监测。     

重症甲型H1N1流感4例胸部影像学表现

目的 探讨重症甲型H1N1流感的胸部影像学表现,为临床早期诊断提供依据.方法 对2009年11月至12月确诊的4例重症甲型H1N1流感患者的临床表现、实验室及影像学资料进行回顾性分析.结果 4例重症甲型H1N1流感中:(1)发热比例高;(2)实验室检查患者白细胞计数正常,中性粒细胞增高;(3)X线胸片检查1例肺纹理增强,3例两肺中下野点状及斑片状高密度影;15～24 h内CT复查.两肺多发实变影,以两肺外围及下叶为主,病变累及范围超过50%以上,病变进展迅速;(4)1例死亡患者为最终发展为急性呼吸窘迫综合征(ARDS)和多脏器功能衰竭(MOF).结论 认识重症甲型H1N1流感的影像学表现,有益于早期诊断,防止发展为急性ARDS和MOF.     

甲型H1N1流感防护体会

<正>甲型流感(简称甲流)为急性呼吸道传染性疾病,其病原体是一种新型的甲型H1N1流感病毒。人感染后的早期症状与普通流感相似,另外甲型H1N1流感病毒核酸检测阳性;分离到甲型H1N1流感病毒;双份血清甲型H1N1流感     

小儿甲型H1N1流感危重症11例临床分析

目的 总结11例小儿甲型H1N1流感重症/危重症的临床特点及诊治经验.方法 对2009年11月22日至2010年2月7日收入笔者医院隔离ICU病房确诊为甲型H1N1流感重危症的11例患儿进行回顾性分析.结果 11例中,男性5例,女性6例,年龄3个月～11岁,年龄中位数为3岁,4例有基础性疾病(4/11),出现呼吸系统重危症多见于5岁以下,而出现神经系统并发症多在4岁以上;发病后至入院时间为2～7天,住院至入ICU时间为1～3天,其中4例并发重症肺炎,3例并发急性呼吸窘迫综合征(ARDS);4例并发脑病、脑炎,其中1例合并多脏器功能不全.入院后给予奥司他韦及免疫球蛋白、糖皮质激素及抗生素等综合治疗,4例行机械通气,4例降颅压处理.10例好转或治愈出院,1例放弃治疗后死亡.结论 有基础疾病及5岁以下是儿童发生重危症的高危因素,重症肺炎、ARDS多见于5岁以下,而并发神经系统症状者多见于年长儿童(>4岁),早期给予奥司他韦、呼吸支持、降颅压、抗细菌感染及免疫调节等综合治疗是降低重危患儿病死率的关键.     

人流感病毒H1N1与禽流感病毒H5N1感染人神经胶质细胞的实验研究

目的：研究人流感病毒（H1N1）及禽流感病毒（H5N1）感染人神经胶质细胞后,促炎症因子的分泌特点。方法：分离培养人胶质细胞,用H1N1及H5N1分别感染刺激人胶质细胞;用RT-PCR技术探求白细胞介素（IL）-1β、-6和肿瘤坏死因子（TNF）-α变化。结果：与阴性对照比,H1N1和H5N1感染人神经胶质细胞IL-1β、-6和TNF-α的表达量均增高,且H5N1的表达量多于H1N1。结论：H1N1与H5N1可体外感染人神经胶质细胞,并诱导其分泌大量促炎症因子,提示此与流感病毒感染中枢神经系统所致的功能紊乱及免疫病理损伤有关。     

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.     

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.

     

20例儿童甲型H1N1流感危重症的病例分析

目的分析甲型H1N1流感危重症的临床特点,总结治疗经验。方法回顾性分析20例甲型H1N1流感危重症的临床表现、实验室检查、影像表现。结果甲型H1N1流感危重症不仅见于婴幼儿和有原发基础病的儿童,也可见于体健的年长儿;常合并细菌、真菌、支原体、或其他病毒的感染;均伴有多脏器功能不全;好转后短期内随诊未留有后遗症。结论对甲型H1N1流感患儿早期作出正确的判断、及时积极的治疗有利于阻断和延缓病情进展、降低病死率、改善预后。     

Comorbid presentation of severe novel influenza A (H1N1) and Evans syndrome: a case report

One 22-month-old boy who was admitted for a fever lasting 6 days as well as a cough and wheezing lasting 2 days was reported. He was diagnosed with influenza A (H1N1, severe type), severe pneumonia, acute respiratory distress syndrome (ARDS), Evans syndrome and multiple organ failure. This is the first case of novel influenza A (H1N1) and Evans syndrome. The pathogenesis is still unknown.     

Comorbid presentation of severe novel influenza A (H1N1) and Evans syndrome: a case report

One 22-month-old boy who was admitted for a fever lasting 6 days as well as a cough and wheezing lasting 2 days was reported. He was diagnosed with influenza A (H1N1, severe type), severe pneumonia, acute respiratory distress syndrome (ARDS), Evans syndrome and multiple organ failure. This is the first case of novel influenza A (H1N1) and Evans syndrome. The pathogenesis is still unknown.

     

儿童重症甲型H1N1流感10例临床分析

目的总结小儿甲型H1N1流感重症患儿的临床特点及治疗措施。方法对2009年11月19日至12月11日期间我院PICU和传染科收治的10例出现甲型H1N1流感样症状合并肺炎、低氧血症或急性呼吸窘迫综合症（ARDS）患儿的临床特点、治疗方法及转归等资料进行分析。结果10例患儿全部经咽拭子检测甲型H1N1流感病毒核酸阳性;患儿平均年龄为（6.3±3．4）岁,其中〈5岁的3例;患儿平均体重（24．4±7．6）kg,体重指数〉30的有2例;5例既往有哮喘或过敏史;所有患儿都表现有典型呼吸系统症状,6例P／F比值〈300的病例不需要机械通气,吸氧和综合治疗可恢复;4例需行机械通气治疗,采用肺保护性通气策略和高PEEP效果良好;9例小剂量激素治疗的病例快速恢复,而1例大剂量激素冲击的病例病程迁延并继发真菌感染;10mo的随访提示肺功能和胸片均恢复正常。结论重症甲型H1N1流感患儿病情进展迅速,以呼吸困难、低氧血症为突出表现,可发生多器官功能障碍综合症;奥司他韦抗病毒、肺保护性通气策略及综合治疗可有效治疗。     

24例甲型H1N1流感并发重症肺炎患者的临床分析

目的：探讨新型病原体甲型H1N1流感病毒所致危重患者的临床特征,为判断病情和治疗提供参考。方法：对24例甲型H1N1流感并发重症肺炎患者的一般临床资料、症状、体征、辅助检查、诊断及治疗方法和结果进行分析。结果：24例患者平均年龄（28.73±9.24)岁,其中孕妇2例（8.3%）,肥胖［体质指数（BMI）≥30］18例(75%),有慢性基础疾病者2例（8.3%）,包括支气管哮喘1例,肾移植术后1例。患者以发热、咽痛、气短为主要症状。双肺多发实变20例（83.3%）。24例患者均给予抗病毒治疗（奥司他韦75 mg或150 mg每日2次口服）,其中22例（91.6%）患者应用激素治疗,18例（75.0%）患者采用机械通气治疗,6例(25.0%)患者经气管插管行机械通气治疗,2例（8.3%）患者死亡。结论：甲型H1N1流感并发重症肺炎患者以青壮年为主,孕妇、肥胖、有慢性基础疾病者感染后易并发重症肺炎,应尽早应用抗病毒药物、合理应用糖皮质激素和人工通气辅助治疗,张力性气胸、多脏器功能不全等相关并发症是其主要死亡原因。     

甲型H1N1肺炎的影像学特征

目的 探讨甲型H1N1病毒所致肺炎的影像学特征。方法 回顾性分析27例经实验室证实的甲型H1N1肺炎患者的胸部X线及CT影像学表现。结果 按照甲型H1N1病毒肺炎的受累面积,将27例患者按初诊时肺部的影像改变程度分为轻、中、重度3种类型。轻度者10例,表现为散在分布的、斑片状磨玻璃样阴影;中度者9例,表现为双肺散在分布的、多发片状实变阴影及结节影,5例合并胸腔积液,并伴有轻、中度代偿性肺气肿;重度者8例,表现为双肺大片实变阴影伴有空洞,其中2例合并霉菌球,3例伴有支气管扩张,4例合并纵隔及胸壁皮下气肿,均伴有双侧胸腔积液及中、重度肺气肿。6例死亡病例中,1例为轻度肺炎恶化死亡,1例为中度肺炎转化为重度肺炎后死亡,其他4例为重度肺炎病例。结论 甲型H1N1肺炎表现为多肺段受累的磨玻璃样变和实变,重度者常伴有空洞、支气管扩张、胸腔积液、纵隔皮下气肿及霉菌感染,死亡率高。