九例孕产妇甲型H1N1流感重症病例临床分析  

Clinical Analysis of Severe H1N1 Influenza in Pregnant and Postpartum Women

作　　者：鲍永霞[1] 王威[1] 王晶[1] 曲波[1] 赵勇华[1] 黄海英[1] 

机构地区：[1]哈尔滨医科大学附属第二医院观察病房,黑龙江哈尔滨150086

出　　处：《中国呼吸与危重监护杂志》2010年第3期234-238,共5页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨孕产妇甲型H1N1流感重症病例的临床特征和治疗方法。方法对2009年10月至12月收治的9例孕产妇甲型H1N1流感重症确诊病例的临床特征和治疗过程进行回顾性分析。结果 9例患者中,7例孕妇,2例产妇,7例孕妇中3例在住院期间实施了剖宫产手术。9例患者均出现发热,7例患者发热持续达3d以上。9例均有咳嗽、咯痰,7例呼吸困难。5例肺部可闻及湿啰音.乏力、肌肉酸痛等全身症状不重,不伴消化道症状。3例患者白细胞计数降低,6例中性粒细胞升高,7例淋巴细胞降低。肝功异常4例。心肌酶指标异常5例。低氧血症8例,5例PaO2低于40mmHg。9例患者胸部X线片及CT检查均有双肺炎改变。9例患者均在入院后服用奥司他韦抗病毒治疗。8例给予抗生素治疗。5例重症呼吸衰竭及双肺重症肺炎的患者给予了糖皮质激素治疗。5例重症患者使用了无创呼吸机治疗,1例后改为有创呼吸机治疗,最终死亡。其余患者及剖宫产后的婴儿均存活。结论孕产期妇女出现流感样症状后较易发展为重症病例,病程进展快,病情重,甚至危及孕产妇生命。死因多为肺炎及随后出现的急性呼吸窘迫综合征,应当给予高度重视。Objective To investigate the clinical characteristics and treatment of severe H1N1 influenza during pregnancy and postpartum.Methods Clinical data of 7 pregnant women and 2 postpartum women with severe H1N1 influenza admitted from October to December 2009 were reviewed.Results Three pregnant women underwent caesarean section during hospitalization.The main symptoms included fever （in 9 cases,and fever lasted more than 3 days in 7 cases）,cough and sputum （in 9 cases）,and dyspnea （in 7 cases）.Asthenia and muscular soreness were not serious,and there were no accompanying symptoms of digestive tract.Moist rales were heard in 5 cases.White blood cell count decreased in 3 cases,neutrophils increased in 6 cases,and lymphocytes reduced in 7 cases.Hepatic enzymes were abnormal in 4 cases,and myocardial enzymes were abnormal in 5 cases.8 patients had hypoxemia,with PaO2 less than 40 mm Hg in 5 cases.Chest X-ray films and CT showed double pneumonia in 9 patients.9 patients were given oseltamivir antiviral treatment.8 cases were given antibiotic therapy.5 patients with bilateral severe pneumonia and respiratory failure were given corticosteriod therapy.5 severe patients were treated with non-invasive ventilation.One case switched to invasive ventilation and eventually died.Conclusions Pregnant and postpartum women with influenza H1N1 are likely to develop into severe condition which is commonly rapidly progressive and even life-threatening.The main causes of death are pneumonia and acute respiratory distress syndrome.

关 键 词：重症甲型H1N1流感 妊娠 产后 奥司他韦 

分 类 号：R714.2[医药卫生—妇产科学] R511.7[医药卫生—临床医学]