2009年甲型H1N1流感患者临床特点的研究

目的调查2009年甲型H1N1流感患者的临床特点。方法通过调查2009年11月至2010年2月符合流感疑似病例收治入院的136例患者,明确2009甲型H1N1流感组,季节性甲型流感组和非流感组的人口学情况,肺炎发生的差异,危重症发生的差异,以及实验室检测参数的差异,筛选出需要住院的流感疑似患者发生肺炎的危险因素。结果 2009甲型H1N1流感发病年龄更年轻（36±17岁）;孕妇的构成比（42.2%）高于其他组;发生肺炎的构成比（51.11%）高于其他组;病死1例。D-二聚体、AST、LDH异常增加的构成比明显大于其他发热患者。结论甲型H1N1流感的易感人群是年轻人和孕妇。甲型H1N1流感是发生肺炎的危险因素,容易并发肺炎和呼吸衰竭,及引起血凝系统、骨骼肌、心肌的损害。     

97例甲型H1N1流感确诊病例临床分析

目的分析甲型H1N1流感确诊病例的临床特点。方法收集97例甲型H1N1流感确诊病例的临床资料并进行回顾性分析。结果97例甲型H1N1流感确诊病例均为轻症病例,主要是本土病例,男性多于女性,学生为主,青少年居多,平均年龄（23．72±4．56）岁,80．0％来自集体单位人群;否认有接触史者占63．92％,无明确诱因占82．47％。首发症状主要为发热、咽部不适、全身酸痛,最常见的症状依次为发热、咽部不适、咳嗽,主要症状组合为发热并咽部不适、发热并咳嗽和3种症状同时出现,体征不明显;发热以中低热为主,热程3天,部分患者不发热;血常规以白细胞正常或降低,淋巴细胞百分比增加或正常为主,57．73％的患者c反应蛋白增高;病程5天,最长不超过10天,预后良好。结论甲型H1N1流感的临床表现并不特异,掌握其临床特点有助于早期识别和规范治疗。     

重症甲型H1N1流感14例临床分析

目的探讨重症甲型H1N1流感的临床特点。方法对我院确诊的14例重症甲型H1N1流感临床特点和治疗进行回顾性分析。结果所有确诊重症甲型H1N1流感病例均有发热等流感样症状,易继发肺部感染等,白细胞(WBC)和淋巴细胞(L)减低,早期给予抗病毒等综合治疗,效果良好。结论重症甲型H lN1流感发病以年轻群体为主,传染性高于季节性流感。早期给予奥司他韦等抗病毒治疗,辅以中药施治,疗效肯定。     

Clinical study of invasive pulmonary aspergillosis following influenza A H1N1

This study to analyze the clinical characteristics of patients with invasive pulmonary aspergillosis (IPA) following influenza A (H1N1) infection.We retrospectively analyzed 10 cases with IPA following H1N1 infection. The clinical manifestations, laboratory examination results, chest computed tomography, and treatments were analyzed.Clinical manifestations: all 10 cases had typical flu-like symptoms at the onset of the disease, among which 7 patients developed dyspnea in the late stage, and 8 patients had hemoptysis. Laboratory examination: the absolute and percentage of peripheral blood lymphocytes in all 10 patients were declined, among which 5 cases were with decreased CD3⁺ CD4⁺ T cells/lymphocytes; 9 cases with increased bronchoalveolar lavage fluid galactomannan; 6 cases with increased serum galactomannan; 1 case with bronchoalveolar lavage fluid cultured aspergillus fumigatus; and 2 cases with aspergillus by second-generation sequencing. Chest computed tomography: all patients showed multiple diffused ground-glass opacities at the beginning, along with linear or reticular interstitial changes. Two cases had multiple subarachnoid nodules with halo signs, 3 cases had consolidation in multiple segments of both lungs, 2 cases had cavities, and 4 cases were with pleural effusion. Treatment: 10 patients were treated with antiviral and anti-Aspergillus drugs after admission. Four patients received respiratory support. All 10 cases were cured and discharged.Early diagnosis of IPA in influenza A (H1N1) patients is the key to successful treatment.     

H1N1 influenza: critical care aspects

During the Northern Hemisphere spring of 2009, a novel H1N1 influenza A virus emerged in Mexico, causing widespread human infection and acute critical respiratory illness. The 2009 H1N1 virus spread initially to the United States and Canada, with subsequent rapid global dissemination, leading the World Health Organization (WHO) to declare "a public health emergency of international concern" in April 2009, and upgrading the viral threat to pandemic status in June 2009. Despite initial fears, the severity of the 2009 H1N1 pandemic overall did not differ significantly from that of seasonal influenza. However, the demographics of those at risk of severe illness did differ (affecting children and young adults, rather than the very young and the very old). The 2009 H1N1 pandemic led to rapid implementation of health care initiatives, including the provision of critical care services, to limit the effect of the influenza outbreak on the community. This review focuses on the critical care response to the H1N1 pandemic and examines whether the implementation of critical care services as planned a priori matched the reality of the clinical workload and the patient burden that transpired during the 2009 H1N1 influenza pandemic.     

103例甲型H1N1流感临床分析

目的:探讨2009年甲型H1N1流感的临床特点及预后。方法:回顾性分析2009年8月至2010年1月北京安贞医院98例甲型H1N1流感患者及5例外院会诊重症患者的临床资料。结果:本组病例中平均年龄(31.06±13.43)岁。主要临床表现为发热(100%)、咳嗽(88.3%)及畏寒(81.6%)等。重症及危重症患者中病死率为22.2%,并发症居前3位的是细菌感染、急性呼吸窘迫综合征(ARDS)、多脏器功能衰竭(MODS),其发生率分别为85.7%、57.1%及28.6%。慢性基础性疾病为重症及危重症病例发生的重要影响因素。结论:甲型H1N1流感以青壮年发病为主,主要临床表现为呼吸道症状,重症病例中多存在二重感染,并有可能存在凝血障碍,呼吸性碱中毒,低氧血症或Ⅰ型呼吸衰竭,且存在慢性基础性疾病更易发生。     

甲型H1N1流感95例临床分析

目的分析甲型H1N1流感的临床特征。方法对我院2009年7月—2009年9月收治的95例确诊为甲型H1N1流感患者的病例资料进行回顾性分析。结果昆明地区甲型H1N1流感患者常见临床表现为发热、咽痛、咳嗽、咯痰,咽部充血,白细胞数减少、中性粒细胞比例下降、淋巴细胞及单核细胞比例升高,咽拭子甲型H1N1病毒核酸阳性(100%)。未发现重症病例及严重并发症。采取口服磷酸奥司他韦、双黄连口服液、莲花清瘟胶囊等中西医结合治疗,效果较好,无死亡病例。结论昆明地区甲型H1N1流感临床表现典型,并发症少,但其传染性强,防控重点地区应放在人口密集的学校。     

甲型H1N1流感96例临床观察

目的探讨辽阳地区甲型H1N1流感的临床特点。方法分析2009年9—10月我市收治的96例甲型H1N1流感患者的临床表现、实验室检查结果、治疗及预后特点。结果辽阳地区甲型H1N1流感以青少年学生多发;绝大多数病例临床表现类似于普通感冒,少数病例出现CK、AIJT、AST升高,极少数病例可出现口周疱疹及皮疹;重症发生率为4．2％;连花清瘟胶囊和（或）痰热清注射液治疗有效。结论辽阳地区甲型H1N1流感临床经过良好,无危重症病例,治愈率为100％。中西医结合治疗有效。     

甲型H1N1流行性感冒的临床特征与防控策略

甲型H1N1流感（influenza A HIN1 virus）于2009年3月18日首先在墨西哥出现,疫情迅速蔓延,席卷全球。     

C反应蛋白在新型A/H1N1流感中的意义

目的探讨C反应蛋白(CRP)在新型A/H1N1流感(简称甲流)的临床应用价值。方法检测45例甲流患者CRP、白细胞计数(WBC)、中性粒细胞计数百分比(N),痰培养及X线胸片,同时给予奥司他韦抗病毒及抗感染治疗,并比较这些指标治疗前后的的变化。结果甲流患者治疗前血清CRP显著高于治疗后(P0.01),而WBC及N在治疗前后变化不大(P0.05)。结论CRP升高不仅可以提示重症甲流及预后。是甲流一个良好的观察指标,比WBC更敏感。     

危重型新型A/H1N1流感6例临床分析

目的提高危重型新型A/H1N1流感（简称甲流）的诊疗效果。方法对2009年11月~2010年1月我院发热隔离病区6例危重型甲流的临床资料进行回顾性分析。结果危重型甲流临床表现以发热、咳嗽、咯血、呼吸困难为主要症状,均出现呼吸衰竭,肺部病灶进展快,均有3个以上肺叶受累,其中2例（33%）发展为ARDS,且合并症及并发症较多。经奥司他韦、利巴韦林抗病毒,亚胺培南西司他丁、伊曲康唑等抗感染及加强支持、保护重要脏器功能,患者均康复出院。结论早发现、早诊断、早期合理使用抗病毒治疗,积极处理合并症及并发症、维护心、肝、肾等多脏器功能,防治多器官功能衰竭可挽救患者的生命。     

危重型新型A/H1N1流感6例临床分析

目的 提高危重型新型A/H1N1流感(简称甲流)的诊疗效果.方法 对2009年11月至2010年1月我院发热隔离病区6例危重型甲流的临床资料进行回顾性分析.结果 危重型甲流临床表现以发热、咳嗽、咯血、呼吸困难为主要症状,均出现呼吸衰竭,肺部病灶进展快,均有3个以上肺叶受累,其中2例发展为急性呼吸窘迫综合征,且合并症及并发症较多.经奥司他韦、利巴韦林抗病毒和亚胺培南西司他丁、伊曲康唑等抗感染以及加强支持、保护重要脏器功能,患者均康复出院.结论 早发现、早诊断、早期合理使用抗病毒治疗,积极处理合并症及并发症,维护心、肝、肾等多脏器功能,防治多器官功能衰竭,可挽救患者的生命.     

危重型新型A/H1N1流感6例临床分析

目的 提高危重型新型A/H1N1流感(简称甲流)的诊疗效果.方法 对2009年11月至2010年1月我院发热隔离病区6例危重型甲流的临床资料进行回顾性分析.结果 危重型甲流临床表现以发热、咳嗽、咯血、呼吸困难为主要症状,均出现呼吸衰竭,肺部病灶进展快,均有3个以上肺叶受累,其中2例发展为急性呼吸窘迫综合征,且合并症及并发症较多.经奥司他韦、利巴韦林抗病毒和亚胺培南西司他丁、伊曲康唑等抗感染以及加强支持、保护重要脏器功能,患者均康复出院.结论 早发现、早诊断、早期合理使用抗病毒治疗,积极处理合并症及并发症,维护心、肝、肾等多脏器功能,防治多器官功能衰竭,可挽救患者的生命.     

危重型新型A/H1N1流感6例临床分析

目的 提高危重型新型A/H1N1流感(简称甲流)的诊疗效果.方法 对2009年11月至2010年1月我院发热隔离病区6例危重型甲流的临床资料进行回顾性分析.结果 危重型甲流临床表现以发热、咳嗽、咯血、呼吸困难为主要症状,均出现呼吸衰竭,肺部病灶进展快,均有3个以上肺叶受累,其中2例发展为急性呼吸窘迫综合征,且合并症及并发症较多.经奥司他韦、利巴韦林抗病毒和亚胺培南西司他丁、伊曲康唑等抗感染以及加强支持、保护重要脏器功能,患者均康复出院.结论 早发现、早诊断、早期合理使用抗病毒治疗,积极处理合并症及并发症,维护心、肝、肾等多脏器功能,防治多器官功能衰竭,可挽救患者的生命.     

儿童甲型H1N1流行性感冒病毒相关性肺炎的临床特征

目的 了解儿童甲型H1N1流行性感冒(流感)病毒相关性肺炎的临床流行特征.方法 通过描述性研究对2009年上海复旦大学附属儿科医院收治的30例甲型H1N1流感病毒所致肺炎的患儿做临床及流行病学分析.中位数比较采用秩和检验,率的比较采用精确卡方检验.结果 30例确诊为甲型H1N1流感合并肺炎的患儿中,年龄中位数为5.9岁,5例有基础疾病史,占16.7%.有明确发热病例暴露史的20例,占66.7%.所有患儿均有发热和咳嗽,11例伴气促,占36.7%,10例伴喘息,占33.3%.11例患儿WBC＜4.0×109/L,占36.7%,2例PLT减少,占6.7%.所有患儿入院时胸部X线片提示肺部有单侧或双侧片状渗出性病灶,4例危重症患儿肺部多处大片状渗出伴肺水肿,占13.3%,1例危重症肺炎患儿发病后3个月和9个月复查胸部CT提示不同程度肺纤维化,占3.3%,3例同时伴纵隔积气和皮下积气,占10.0%,6例并发急性呼吸衰竭,占20.0%,3例伴支气管哮喘急性发作,占10.0%,1例合并脑炎,占3.3%.所有患儿均给予奥司他书和抗菌药物治疗,4例接受机械通气,均治愈或好转出院.发病2 d内和2 d后接受奥司他韦治疗的患儿的热程中位数比较差异有统计学意义(2 d比5 d,Z=-8.015,P＜0.01).结论 学龄前和学龄儿童易感染甲型H1N1流感病毒,可并发严重的肺部疾病.在发病早期采用奥司他韦治疗,可缩短热程,降低危重并发症的发生.     

Pandemic H1N1 influenza

The 2009 H1N1 influenza A virus that has targeted not only those with chronic medical illness, the very young and old, but also a large segment of the patient population that has previously been afforded relative protection - those who are young, generally healthy, and immune naive. The illness is mild in most, but results in hospitalization and severe ARDS in an important minority. Among those who become critically ill, 20-40% will die, predominantly of severe hypoxic respiratory failure. However, and potentially in part due to the young age of those affected, intensive care with aggressive oxygenation support will allow most people to recover. The volume of patients infected and with critical illness placed substantial strain on the capacity of the health care system and critical care most specifically. Despite this, the 2009 pandemic has engaged our specialty and highlighted its importance like no other. Thus far, the national and global critical care response has been brisk, collaborative and helpful - not only for this pandemic, but for subsequent challenges in years ahead.