新型甲型H1N1流感重症和危重病例75例临床分析.PDF

6 Chinese Journalof Practical InternalMedicine Jan. 2010 Vol. 30 No. 1 H1N1 H1N1 75 代 冰,温 华, 谭 伟,孙龙凤,赵洪文, 康 健 : 1005- 2194( 2010) 01- 0006- 04 : R5 : A : 分析新型甲型 H1N1流感重症和危重病例的临床特点, 并对其诊治方法进行探讨 对 2009年 10月24 日至 12月 12 日中国医科大学附属第一医院收治的 75例新型甲型 H1N1流感重症 和危重病例的临床症状实验室检查及影像学资料进行回顾性分析 75例患者中男 54例, 女 21 例年龄 18~ 66岁, 平均 4214岁重症患者 29例,危重症患者 46例16例患者有明确的接触史, 平均 潜伏期 31 5 d; 5610%的患者以发热为首发症状, 101 7%的患者病程中没有出现发热, 2010%的患者出现血 性痰; 901 7%的患者肺部可闻及啰音实验室检查: 7817%的患者中性粒细胞比率升高, 7417%的患者淋 巴细胞比率降低; 561 7% 的患者白蛋白降低, 乳酸脱氢酶( LDH) 明显升高( 5812% ); 外周血 T 细胞亚群 CD4明显降低( 5711% ) 肺 CT主要表现为双肺多发的斑片影和磨玻璃影出现急性呼吸窘迫综合征 ( ARDS) 23例,其中 10例死亡 新型甲型 H 1N1流感诊治的关键是早期识别重症和危重病例,并 及时给予奥司他韦治疗,综合支持治疗可取得较好的疗效 : 新型甲型 H1N1流感;急症与重症; 奥司他韦 Clinical analysis of 75 severe and critical patients w ith novel influenza A ( H1N1). DA I B ing, WEN H ua, TAN W e,i S UN L ong2f eng, ZHAOH ong2wen, KAN G J ian. D epartm ent of Resp ira toryM edicine, the F irstAff ilia2 ted H osp ital of ChineseM ed ical Un ivers ity, Sheny ang 110001, China A stract: O jective To analyze the clinical features of patients with severe and critical influenza A (H 1N1), and to discuss themethods for its diagnosis and treatment. M ethods The clinical features, laboratory findings, and the mi agedata of 75 influenzaA(H 1N1) patients, whowere adm itted to theFirstAffiliatedHospital ofChinaM edicalUniversity during October24, 2009- December 12, 2009, were retrospectively analyzed. R esults The patients included 29 severecases and 46 criticalcases, 54males and 21 females, with an age range of 18~ 66 years and amean of 4214 years old. Sixteen patients had definite contact history; the mean latency was 31 5 days. Themost common initial symptoms included fever( 561 0% ), bloody sputum( 201 0% ) and rales( 901 7% ). Blood routine showed that 7817% of patients had i