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目的了解无基础疾病者感染甲型H1N1流感危重症的临床特点、治疗和转归。方法观察北京地坛医院2009年10月3日—12月31日收治的32例无基础疾病者感染甲型H1N1流感危重症的临床特点、主要治疗和转归。结果危重症易发生于65岁以下(96.9%)及肥胖者(71.0%)。甲型H1N1流感危重症临床特点为高热(96.9%)、呼吸困难(93.8%)、双肺可闻及干湿性啰音(93.8%)、咳血痰(62.5%),部分出现呕吐或腹泻(25.0%)。入院时均有低氧血症[氧合指数为(157.7±65.5)mmHg],25例并发急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS),3例在发病早期并发多脏器功能障碍(multiple organ dysfunction syndrome,MODS),14例继发感染(包括细菌感染和真菌感染)。所有患者均接受磷酸奥司他韦治疗,开始使用平均病日为(5.4±2.6)d(中位数5d);26例(81.3%)住ICU治疗,入住ICU时平均病日为(5.5±2.1)d,ICU治疗天数为(10.5±8.1)d;23例(71.9%)接受机械通气治疗,12例(37.5%)接受有创呼吸支持,有创呼吸支持开始平均病日为(6.2±4.0)d,其中1例使用体外膜肺氧合治疗。4例死亡,死亡原因为ARDS(3例)和感染性休克(1例)。结论甲型H1N1流感危重症病例多发生于中青年及肥胖人群。危重症病例均发展为严重低氧血症,部分早期出现MODS,大部分须住ICU,且须机械通气治疗。
Objective To understand the clinical characteristics, treatment and prognosis of critically ill patients infected with Influenza A (H1N1) virus without underlying diseases. Methods The clinical features, main treatment and prognosis of 32 critically ill patients infected with Influenza A (H1N1) in Beijing Ditan Hospital from October 3 to December 31, 2009 were observed. The results of critically ill patients prone to 65 years of age (96.9%) and obese (71.0%). Influenza A (H1N1) critically ill clinical features are high fever (96.9%), dyspnea (93.8%), lungs can be heard and wet and dry rales (93.8%), hemoptysis sputum (62.5%), some vomiting or diarrhea 25.0%). Hypoxemia (oxygenation index: (157.7 ± 65.5) mmHg), 25 patients with acute respiratory distress syndrome (ARDS) and 3 patients with multiple organ dysfunction multiple organ dysfunction syndrome, MODS) and 14 secondary infections (including bacterial and fungal infections). All patients were treated with oseltamivir phosphate. The mean onset of disease was (5.4 ± 2.6) d (median 5 days) and ICU (26.3% 2.1) d, ICU treatment days was (10.5 ± 8.1) days; 23 cases (71.9%) received mechanical ventilation and 12 cases (37.5%) received invasive respiratory support. The average onset day of invasive respiratory support was (6.2 ± 4.0) d, of which 1 case was treated with extracorporeal membrane oxygenation. 4 died, the cause of death was ARDS (3 cases) and septic shock (1 case). Conclusion Influenza A (H1N1) critically ill cases occurred mostly in middle-aged and obese people. Critically ill patients develop severe hypoxemia, some early MODS, most of them have to live in ICU, and mechanical ventilation.