新型甲型H_1N_1流感危重症23例临床分析

目的探讨新型甲型H1N1流感危重症的临床特征、诊断及治疗方法。方法对已经确诊的23例新型甲型H1N1流感危重症患者的临床特点、治疗过程、治疗效果进行综合分析。结果新型甲型H1N1流感危重症孕妇患病率达到47.9%,60%患者体温高于38.5℃。症状以咳嗽、咳痰、胸闷为主,且80%患者有湿啰音。影像为片絮状影,弥散实变影。血常规检查提示白细胞计数偏低,中性粒细胞、淋巴细胞、血小板与正常相比无统计学意义。生化检查中,谷草转氨酶、碱性磷酸酶明显升高,总胆红素及直接胆红素升高。乳酸脱氢酶及α-羟丁酸脱氢酶明显升高。患者的血肌酐、尿素氮正常,尿酸升高。血浆中钠、钾、氯、钙均降低。结论新型甲型H1N1流感危重症的体征、影像、生化均有别于其他病毒性肺炎,预后与就诊时间、妊娠密切相关,尽早终止妊娠与机械通气,糖皮质激素的早期大量应用可改善预后。

Clinical analysis of 23 cases with severe influenza A H_1N_1 infection

Objective To explore the characteristics and clinical diagnosis and treatment of severe A H1N1 influenza pneumonia.Methods Analyzed the clinical characteristic,treatment process,treatment results of 23 patients with clinically confirmed influenza A（H1N1） infection.Results The cases of pregnant women with influenza A（H1N1） infection accounte for 47.9% of severe and critical patients.The temperature of the 60% of the patients were more than 38.5℃,and the symptoms were cough,cough up phlegm and shortness of breath.White blood count was down,the difference in the level of the count of Neutrophils,lymphocytes and platelet was no significant.Levels of the significant increase in the leveh of laetate dehydrogenase,α-hydroxy-butyrate dehydrogenase,alkaline phosphoric acid enzymes,direct bilirubln and total bilirubln.The predominant imaging findings were textensive GGOs and large patchy consolidations.The level of serum creatinine and blood urea nitrogen was normal,but the level of insulin increased.The concentration of the sodium,potassium,chlorine and calcium in the plasma were all down.Conclusion The symptoms,imaging characteristics and biochemical characteristics of severe A H1N1 influenza pneumonia are different from the other virus pneumonia.Prognosis is closely related to diagnosis time and pregnancy,and early termination of pregnancy,mechanical ventilation,early a large number of applications of sugar massive cortical hormone can improve the prognosis.