18例高原重症甲型H1N1流感病例临床分析

目的探讨重症甲型H1N1流感病例临床特征，发病特点及治疗方法。方法对2009年10月～2010年1月笔者所在科确诊的18例重症甲型H1N1流感病例临床特征、治疗转归、预后进行分析总结。结果18例重症甲型H1N1流感病例中，男12例，女6例；发病年龄18～65岁，其中25～45岁12例，〈20岁1例，〉50岁5例。其中西宁市区3例，市属三县14例，内地输入性病例1例。所有病例均有发热表现，就诊时体温波动于38．2℃～40．0℃间，11例表现为发热伴咳嗽，4例表现为咳嗽、咳血痰。14例既往体健，无特殊病史，2例既往慢性阻塞性肺病，1例系晚期妊娠，1例合并有类风湿性关节炎，长期口服激素治疗。脏器受累前三位依次为肺部（100％），心脏（66．7％），肝脏（55．2％）。发生多器官功能衰竭者6例，接受有创机械通气治疗12例，3例无创通气治疗，3例给予面罩吸氧。治疗上均给予磷酸奥司他韦（75mg，每天两次口服），在此基础上加用广谱抗生素及激素治疗，并给予保护心肌、维持水、电解质、酸碱平衡治疗。死亡2例。结论重症甲型H1N1流感病例以青壮年多见，早期给予磷酸奥司他韦口服者预后较好，发生多脏器衰竭者死亡率高，预后差。

Study of symptom of 18 severe highland patients with pandemic HINI influenza

Objective To explore the clinical characteristics of patients with severe pandemic H1N1 influenza A, symptom and therpy. Methods To analyze and sunnnar/ze the clinical characteristics, treatment outcome, prognosis of patients with lg severe pandemic HI NI influenza A from October 2009 to January 2010. Results 18 patients with severe cases of pandemic H1 N1 influenza, males 12, femmale 6 , age of onset is 1 g -65 years old, and among them, 12 cases are 25 -45 years old, 1 case of 20 -years old, 5 cases of 50 -years old. Between them, 3 cases of Xining City, three counties in 14 cases of municipal, imported 1 case in the Mainland. All patients had fever, fluctuations in body temperature between 38.2 ℃- 40.0℃, among them 11 cases had fever and cough, 4 cases of cough and bloody sputum. 14 cases of past physical health, no specific medical history, 2 cases of chronic obstructive pulmonary disease past, 1 case was late pregnancy , I patient with rheumatoid arthritis, which had long - term oral hormone theyapy. The most frequent organ dysfunction was seen in lung （100%）, cardia（66.7% ） and liver（ 55.2 % ） . Multiple organfailure occmTed in 6 cases, and receiving invasive mechanical ventilation in the treatment of 12 cases 3 cases of noninvasive ventilation, 3 patients had given oxygen mask. Treatment weregiven osehamivir phosphate （75 mg, Bid, P. O. ）, in this based on the use of broad - spectrum antibiotics and hormone therapy. And to protect the myocardium, to maintain water, electrolyte, acid - base balance of the treatment. 2 cases died. Conclusion Severe cases of pandemic H1 N1 influenza more common in young adults, and which were given oseltamivir phosphate early had good prognosis, those with multiple organ failure had high mortality and poor prognosis.