重症甲型H1N1流感34例临床分析  

Clinical Analysis of 34 Patients with Severe H1N1 Influenza

作　　者：曾维忠[1] 李舜午[1] 周源[1] 彭苏娜 张溪[1] 

机构地区：[1]株洲市一医院重症监护室,湖南株洲412000

出　　处：《中国呼吸与危重监护杂志》2010年第3期230-233,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的分析重症甲型H1N1流感患者的临床特征,总结和探讨其治疗方法。方法回顾性分析2009年10月至12月入住ICU的34例危重症甲型H1N1流感患者的临床资料。结果患者年龄3个月～60岁,平均(13.9±4.5)岁,<7岁患者24例。发热、咳嗽、进行性呼吸困难为主要症状。WBC总数正常范围21例(61.8%),下降7例(20.6%),增高6例(17.7%)。淋巴细胞正常16例(47.1%),下降6例(17.7%),增高12例(35.3%)。胸片示双肺野或单侧肺小斑片状模糊阴影。肺部CT示弥漫性间质性病变、胸腔积液或支气管扩张。肝功能酶谱和心肌酶谱指标均异常。30例应用奥司他韦、利巴韦林抗病毒治疗,4例使用激素,6例使用丙种球蛋白治疗。8例行气管插管机械通气,5例行无创机械通气治疗。34例患者全部好转或痊愈出院。结论肺、心、肝是甲型H1N1流感病毒损伤机体的主要脏器。机械通气支持治疗是抢救危重症患者的重要手段。Objective To analyze the clinical features and treatment of severe H1N1 influenza.Methods The clinical data of 34 patients with severe H1N1 influenza admitted to intensive care unit from October to December 2009 were reviewed.Results The patients aged 3 months to 60 years with an average of （13.9±4.5） years,of which 24 patients were younger than 7 years old.Fever（30 cases）,cough（32 cases）,progressive shortness of breath（19 cases） were the main symptoms.White blood cell count was normal in 21 cases,increased in 6 cases,and decreased in 7 cases.Lymphocyte count was normal in 16 cases,increased in 12 cases,and decreased in 6 cases.Chest X-ray films showed bilateral or unilateral patchy pulmonary fuzzy shadows in 28 cases.Chest CT showed diffuse interstitial lesion in 1 case,pleural effusion in 2 cases,and bronchiectasis in 1 case.The hepatic and myocardial enzymogram parameters were all abnormal.30 cases were treated by oseltamivir and ribavirin,4 cases by methyllprednisolone,and 6 cases by gamma globulin.8 cases underwent routine intubation and mechanical ventilation,and 5 cases received non-invasive mechanical ventilation.All 34 patients were cured.Conclusions Lung,heart,and liver are the major target organs in severe H1N1 influenza.Mechanical ventilatory support is an important treatment for severe H1N1 influenza.

关 键 词：重症甲型H1N1流感 奥司他韦 机械通气 

分 类 号：R511.7[医药卫生—内科学]