不同孕期重症甲型H1N1流感患者的临床分析  

Analysis of clinical features among severe or critical pregnant women in different trimesters with2009 ~andemic H1N1 infection

作　　者：张鹏俊[1] 曹彬[4] 张帅 吴司南 李燕明 李晓莉[4] 梁立荣[6] 朱建国 杨仕贵[7] 胡克[8] 章洪院[9] 阎锡新[10] 王辰 

机构地区：[1]卫生部北京医院科研处,100730 [2]北京老年医学研究所,100730 [3]呼吸病学研究中心,100730 [4]北京呼吸疾病研究所北京市呼吸与肺循环疾病重点实验室首都医科大学附属北京朝阳医院感染和临床微生物科,100730 [5]呼吸与危重症医学科,100730 [6]北京呼吸疾病研究所北京市呼吸与肺循环疾病重点实验室,100730 [7]浙江大学医学院附属第一医院传染病诊治国家重点实验室 [8]武汉大学人民医院呼吸内科 [9]安徽大学附属第一医院呼吸内科 [10]河北医科大学附属第二医院呼吸内科阎锡新

出　　处：《中华医学杂志》2013年第24期1872-1875,共4页National Medical Journal of China

基　　金：国家自然科学基金（81030032、81070005）;国家“十二五”科技支撑计划（2012BAl05802）

摘　　要：目的分析不同孕期重症甲型H1N1流感患者的临床特征。方法回顾性收集2009年9月1日至12月31日中国大陆地区27个省市综合医院或传染病医院收治的394例重症或危重症甲型H1N1流感孕妇的临床资料，比较孕早、中、晚期患者的临床特点。确诊病例定义为甲型H1N1流感病毒核酸检测阳性，并且符合甲型H1N1流感重症和危重症的诊断标准。基于各变量有完整记录的病例数来计算各变量数据百分比。结果394例患者中有374例（94．9％）感染发生在孕中期和孕晚期；孕早、中、晚期患者均表现为发热及伴有呼吸道症状，但孕中、晚期患者更易出现咳血痰、呼吸困难、合并肺炎；孕中期和晚期使用机械通气的总体比例（44．7％，167／374）显著高于孕早期（3／20）；77例患者死亡，其中72．7％（56／77）死于孕晚期；52．5％（207／394）患者起病后终止妊娠，其中57．0％（118／207）孕周〈37周；有29．0％（60／207）的胎儿死亡。结论妊娠合并甲型H1N1流感的孕中期和孕晚期患者病情较重，孕妇及其胎儿病死率高。Objective To explore the disease course and outcomes of severe or critical pregnant women with 2009 pandemic H1N1 （ pH1N1 ） infection in China. Methods A retrospective observational study was conducted for 394 severe or critical pregnant women with pHI N1 influenza admitted into hospital in 27 Chinese provinces from September 1, 2009 to December 31, 2009. Their clinical features in different trimesters were analyzed. The viral infection of pH1N1 was verified by real-time reverse transcription （rRT）- PCR. Severe and critical cases were defined according to the 2009 H1 N1 clinical guidelines. Results Among them, 374 （94. 9% ） were infected in the second or third trimester. Fever and cough were the most common symptoms in all trimesters. However, hemoptysis, dyspnea and associated pneumonia were likely to occur in the second or third trimester. The ratio of required mechanical ventilation in the second or third trimester （44. 7%, 167/374） was significantly higher than that in the first trimester （3/20）. Among 77 mortality cases, 72. 7% （56/77） died in the third trimester. Pregnancy was terminated after the onset of pH1N1 symptoms in 52. 5% （207/394） pregnant women. And 57. 0% （118/207） of them had delivery 〈 37 weeks and 29. 0% （60/207） fetuses deceased. Conclusion A clinician should be on a high alert for pH1N1 infection in pregnant women, particularly in the second or third trimester.

关 键 词：流感病毒A型 H1N1亚型 孕妇 疾病特征 孕期 

分 类 号：R714[医药卫生—妇产科学]