CAJ | 학술논문

目的了解重症甲型H1 N1流感的临床特点,提高对危重症患者的诊治水平.方法收集2009年9月1日至12月4日天津市11例甲型H1N1流感死亡患者的病历资料进行回顾性分析.结果 11例患者中男6例,女5例;中位年龄25(21～36)岁.孕妇2例,既往存在基础疾病者3例(扩张型心肌病、多发性骨髓瘤、萎缩性胃炎各1例).患者入院时影像学检查示累及肺叶均超过3个,氧合指数均＜30 mm Hg(1 mm Hg=0.133 kPa),均在24 h内给予奥司他韦、甲泼尼龙和机械通气等治疗.治疗过程中均存在顽固性低氧血症和高乳酸脱氢酶,出现气胸或纵隔气肿者4例,出现急性肾功能衰竭和脓气胸者各1例.机械通气3～7 d气道分泌物培养4例检出金黄色葡萄球菌,2例检出曲霉菌.病情均进展迅速,从出现临床症状到就诊的中位时间为4(3～6)d,从出现临床症状到死亡的中位时间为12(8～20)d.结论天津市甲型H1N1流感死亡病例多是既往健康的中青年和孕妇,发病凶险,进展迅速,易并发细菌感染,主要死亡原因是顽固低氧引起的呼吸衰竭.
목적 료해중증갑형H1 N1류감적림상특점,제고대위중증환자적진치수평.방법 수집2009년9월1일지12월4일천진시11례갑형H1N1류감사망환자적병력자료진행회고성분석.결과 11례환자중남6례,녀5례;중위년령25(21～36)세.잉부2례,기왕존재기출질병자3례(확장형심기병、다발성골수류、위축성위염각1례).환자입원시영상학검사시루급폐협균초과3개,양합지수균＜30 mm Hg(1 mm Hg=0.133 kPa),균재24 h내급여오사타위、갑발니룡화궤계통기등치료.치료과정중균존재완고성저양혈증화고유산탈경매,출현기흉혹종격기종자4례,출현급성신공능쇠갈화농기흉자각1례.궤계통기3～7 d기도분비물배양4례검출금황색포도구균,2례검출곡매균.병정균진전신속,종출현림상증상도취진적중위시간위4(3～6)d,종출현림상증상도사망적중위시간위12(8～20)d.결론 천진시갑형H1N1류감사망병례다시기왕건강적중청년화잉부,발병흉험,진전신속,역병발세균감염,주요사망원인시완고저양인기적호흡쇠갈.
Objectiye To describe the clinical characteristics of fatal cases with confirmed A H1N1influenza so as to improve the diagnosis and treatment of this severe disease. Methods We retrospectively analyzed the medical records of 11 fatal cases with A H1 N1 influenza in Tianjin between September 1 and November 4 2009. Results There were 6 males and 5 females with a median age of 25 (21 - 36) years old. Two cases were pregnant women and 3 patients suffered such concurrent disorders as dilated cardiomyopathy, multiple myeloma or atrophic gastritis. Over 3 lung fields were involved on chest imaging studies and the oxygenation index was less than 300 mm Hg at admission. The therapies of oseltamivir and methylprednisolone were administered and mechanical ventilation was initiated within 24 hours. Refractory hypoxemia and a higher level of lactate dehydrogenase were present during treatment. Pneumothorax or mediastinal emphysema occurred in 4 patients, acute renal failure in 1 and pneumopyothorax in 1. The culture of airway secretion at 3 - 7 days after mechanical ventilation showed Staphylococcus aureus in 4 patients and Aspergillus in 2. The progress of disease was so quick that the duration from onset of clinical symptoms to hospitalization was a median of 4 (3 - 6) days and the duration from onset of clinical symptoms to death a median of 12 days. Conclusion The fatal cases with A H1N1 influenza in Tianjin occurred mostly in young individuals and pregnant women. This severe disease had a rapid progression. And bacterial co-infections were quite common. Refractory hypoxemia resulting in respiratory failure was the main mortality reason.