老年重症甲型H1N1流感的临床特征分析  

Clinical features of severe ill old patients with influenza A （H1N1） virus infection in China

作　　者：李燕明[1] 居阳[1] 佟训靓[2] 曹彬[4] 钟雪锋[1] 张鹏俊[3] 王辰[5] 

机构地区：[1]北京医院呼吸与危重症医学科,100730 [2]北京医院老年医学部,100730 [3]北京医院科研处,100730 [4]北京朝阳医院感染与微生物医学科,100020 [5]中日友好医院,北京100029

出　　处：《国际呼吸杂志》2015年第12期899-903,共5页International Journal of Respiration

基　　金：国家十二五科技支撑计划（2012BAI05B02）;卫生部卫生公益性科技行业专项（201302017）

摘　　要：目的：分析老年重症甲型 H1N1流感病例的临床特征和疾病转归,以提高临床救治水平。方法收集2009年9月至12月中国426家医院确诊的重症甲型 H1N1流感住院患者中≥65岁的217例作为研究对象。确诊病例定义为甲型 H1N1流感病毒核酸检测阳性,并符合甲型 H1N1流感重症诊断标准。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。结果入选患者平均年龄（72.9±6.2）岁。82.0%的患者合并1种或以上基础疾病。患者发病到首次就诊的中位时间是24 h,到实验室确诊中位时间是102 h。发热（87.6%）和咳嗽（91.7%）是突出的临床表现,91.6%的患者影像学检查存在肺炎,56.4%的患者氧合指数≤300。入组患者中,死亡34例（15.7%）,其中15例死于呼吸衰竭。死亡患者与存活者相比,在合并重要基础疾病、入院时的呼吸频率、心率、血小板计数、谷丙转氨酶、胆红素、氧合指数等方面存在显著性差异。结论老年甲型 H1N1流感患者多合并基础疾病,出现呼吸、心率增快、肝功能异常、血小板下降等情况提示患者预后不良。Objective To analyze the clinical features and outcomes of severe ill old patients with influenza A （H1N1）virus infection in order to improve the ability of diagnosis and treatment.Methods 21 7 patients above 65 years old with pandemic influenza A （H1N1 ）virus infection were admitted into hospital as severe illness during September and December 2009 in China.The cases was confirmed based on the positive result in real time reverse-transcriptase polymerase chain reaction test.Severe cases were defined according to the 2009 H1N1 clinical guidelines in China.Results The mean age of the 21 7 patients was 72.94±6.20 years old and 82.0% of them were combined with underlying disease.The median time was 24 hours from symptom onset until first time visit and 102 hours until experimental diagnosis was made,respectively.Fever （87.6%） and cough （91.7%） were prominent clinical features of these patients,91.6% of these patients were diagnosed with pneumonia by imaging examination and 56.4% of these patients′ oxygenation index was below 300.34 patients died and 1 5 of them were died from respiratory failure.There were statistical differences in the combination with important underlying disease,respiratory rate,heart rate,platelet counts,glutamic pyruvic transaminase,bilirubin and oxygenation index in admission between death patients and survival patients.Conclusions Most of the old patients with influenza A （H1N1）virus infection are combined with underlying disease.The patients with increased rate of respiratory and heart,abnormal liver function,decreased platelet counts and so on are pointed out with poor prognosis.

关 键 词：甲型流感病毒 H1N1亚型 老年 临床特征 

分 类 号：R511.7[医药卫生—内科学]