21例危/重症甲型H1N1(2009)流感患者临床特征治疗及转归

目的探讨危/重症甲型H1N1流感的临床特征、治疗和转归情况。方法设计调查表,了解安徽医科大学第一附属医院甲流专病病房21例危/重症甲型H1N1流感病例（研究组）的人口学特征、临床症状和体征、实验室检测、治疗及转归,同时使用曹彬等关于中国2009大流行甲型流感（H1N1）病毒感染最初病例的研究样本作为对照,其中危/重症诊断按照卫生部颁布的诊断标准进行,对不同时间点的相关指标也进行比较分析,采用SPSS17.0软件进行统计学分析。结果两组间性别、年龄分布差异无统计学意义,研究组发热持续时间较长,肝功能不良事件发生率也明显高于对照组（P〈0.01）;研究组入院时高热、咳嗽、咳痰、疲乏、腹泻/腹痛、呼吸困难、咽充血、扁桃体肿大发生率均明显高于对照组（P〈0.05）;与对照组相比,研究组更容易出现白细胞升高（P〈0.01）及C反应蛋白升高（P〈0.01）,血清CK、CK-MB、LDH、ALT、AST以及胸部X线检查异常均明显增加（P〈0.05）,血清钾、血清钠也较对照组低（P〈0.05）;随治疗时间延长,患者氧分压有所升高、心率降低、血小板增加;痊愈出院20例,死亡1例。结论危/重症甲型H1N1流感病例与普通感染者有较大差异,体温高、热期长,容易出现多器官系统损害及继发感染,经良好治疗,大多数可以痊愈。

Clinical features, treatment, and outcomes of 21 critical and severe cases of 2009 influenza A/H1N1

Objective To describe the clinical features,treatment,and outcomes of 2009 influenza A(H1N1).Methods Observe 21 critically ill and severe patients(the study group) with 2009 influenza A(H1N1) at special ward for Influenza A infection in our hospital.Demographic characteristics,clinical symptoms and signs,laboratory tests,treatments,as well as clinical outcomes of 21 cases were collected using designed questionnaires.At the same time,we use the study samples in Bin Cao's treatise addressing the Initial cases of 2009 pandemic Influenza A(H1N1) virus infection in China as control group.The critically ill and severe patients were divided according to diagnostic standards promulgated by the Ministry of Health.Relevant indicators at different time points were comparatively analyzed.SPSS 17.0 software was used for statistical analysis.Results There were no significant difference in sex or age distribution between two groups.Compared with the control group,the study group has a longer duration of fever and higher incidence of liver dysfunction(P<0.01).The occurrences of high fever,cough,expectoration,fatigue,diarrhea,abdominal pain,diffi9culty breathing,throat congestion and swollen tonsils in the study group at the time of admission were higher than the control group(P<0.05).The study group was more prone to emerge increased white blood cell count(P<0.01) and C reactive protein(P<0.01).Patients who were in the study group had greater abnormality of creatine kinase(CK) levels,MB isoenzyme of creatine kinase(CK-MB),lactate dehydrogenase(LDH),alanine aminotransferase(ALT),aspartate aminotransferase(AST) in serum and higher dysfunction of Chest X-ray examination(P<0.05).As to potassium and sodium in the serum,its value was lower than the control group.With prolonged treatment,patients have elevated oxygen partial pressure,decreased heart rate and increased platelets.20 patients were cured when discharged and 1 died in 21 patients.Conclusion Critically ill and severe patients with 2009 influenza A(H1N1) had greater differences with ordinary infected person.They had higher body temperature,longer time of fever,more proneness to multiple organ system damage and secondary infection.But most can be cured by good treatment.