中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2010年
6期
411-414
,共4页
邸庆国%李勇%孙宝华%张骞云%刘云峰%张玲%马育霞%刘杰%刘芳
邸慶國%李勇%孫寶華%張鶱雲%劉雲峰%張玲%馬育霞%劉傑%劉芳
저경국%리용%손보화%장건운%류운봉%장령%마육하%류걸%류방
流感病毒A型,H1N1亚型%妊娠%肺炎,病毒性
流感病毒A型,H1N1亞型%妊娠%肺炎,病毒性
류감병독A형,H1N1아형%임신%폐염,병독성
Influenza A virus,H1N1 subtype%Pregnancy%Pneumonia,viral
目的 探讨妊娠合并重症新型甲型H1N1流感(简称甲型流感)患者的临床特点. 方法 对河北沧州市中心医院2009年11月26日至12月20日收治的16例重症甲型流感患者的临床资料进行分析. 结果 16例患者均为青年女性,年龄19～30岁,其中妊娠期妇女15例.16例平均白细胞总数为(6.7±3.2)×109/L,2例低于4×109/L,3例高于10 × 109/L;淋巴细胞平均值为(0.78±0.52)×109/L,14例<1×109/L;12例进行T细胞亚群CD4/CD8检查,其中7例<1.4.15例患者血乳酸脱氢酶中位数值为319 U/L(0.80～850.00 U/L),其中11例增高.16例中4例血钾<3.5 mmol/L;13例检测免疫相关指标,其中5例补体C4高于360 mg/L,1例<90 mg/L;4例C3<750mg/L;免疫球蛋白及免疫复合物检查未见异常.影像学检查示多发性多叶肺炎,主要呈间质样改变或大片实变渗出.需要机械通气辅助呼吸的病例影像学检查符合ARDS影像学表现.4例出现少量胸腔积液,1例合并少量心包积液.2例孕晚期妇女胎死宫内,7例及时剖官产终止妊娠或自然生产者病情稳定. 结论 健康妊娠期妇女是甲型流感的高危人群,并易迅速进展为严重肺炎,甚至出现呼吸衰竭.早期抗病毒、早期终止妊娠、早期氧疗并适时进行机械通气辅助呼吸可改善患者预后.
目的 探討妊娠閤併重癥新型甲型H1N1流感(簡稱甲型流感)患者的臨床特點. 方法 對河北滄州市中心醫院2009年11月26日至12月20日收治的16例重癥甲型流感患者的臨床資料進行分析. 結果 16例患者均為青年女性,年齡19～30歲,其中妊娠期婦女15例.16例平均白細胞總數為(6.7±3.2)×109/L,2例低于4×109/L,3例高于10 × 109/L;淋巴細胞平均值為(0.78±0.52)×109/L,14例<1×109/L;12例進行T細胞亞群CD4/CD8檢查,其中7例<1.4.15例患者血乳痠脫氫酶中位數值為319 U/L(0.80～850.00 U/L),其中11例增高.16例中4例血鉀<3.5 mmol/L;13例檢測免疫相關指標,其中5例補體C4高于360 mg/L,1例<90 mg/L;4例C3<750mg/L;免疫毬蛋白及免疫複閤物檢查未見異常.影像學檢查示多髮性多葉肺炎,主要呈間質樣改變或大片實變滲齣.需要機械通氣輔助呼吸的病例影像學檢查符閤ARDS影像學錶現.4例齣現少量胸腔積液,1例閤併少量心包積液.2例孕晚期婦女胎死宮內,7例及時剖官產終止妊娠或自然生產者病情穩定. 結論 健康妊娠期婦女是甲型流感的高危人群,併易迅速進展為嚴重肺炎,甚至齣現呼吸衰竭.早期抗病毒、早期終止妊娠、早期氧療併適時進行機械通氣輔助呼吸可改善患者預後.
목적 탐토임신합병중증신형갑형H1N1류감(간칭갑형류감)환자적림상특점. 방법 대하북창주시중심의원2009년11월26일지12월20일수치적16례중증갑형류감환자적림상자료진행분석. 결과 16례환자균위청년녀성,년령19～30세,기중임신기부녀15례.16례평균백세포총수위(6.7±3.2)×109/L,2례저우4×109/L,3례고우10 × 109/L;림파세포평균치위(0.78±0.52)×109/L,14례<1×109/L;12례진행T세포아군CD4/CD8검사,기중7례<1.4.15례환자혈유산탈경매중위수치위319 U/L(0.80～850.00 U/L),기중11례증고.16례중4례혈갑<3.5 mmol/L;13례검측면역상관지표,기중5례보체C4고우360 mg/L,1례<90 mg/L;4례C3<750mg/L;면역구단백급면역복합물검사미견이상.영상학검사시다발성다협폐염,주요정간질양개변혹대편실변삼출.수요궤계통기보조호흡적병례영상학검사부합ARDS영상학표현.4례출현소량흉강적액,1례합병소량심포적액.2례잉만기부녀태사궁내,7례급시부관산종지임신혹자연생산자병정은정. 결론 건강임신기부녀시갑형류감적고위인군,병역신속진전위엄중폐염,심지출현호흡쇠갈.조기항병독、조기종지임신、조기양료병괄시진행궤계통기보조호흡가개선환자예후.
Objective To investigate the clinical characteristics of severe influenza A(H1N1)in pregnant women. Methods Sixteen patients with severe pneumonia caused by influenza A(H1N1)were included in this study from November 26 to December 20,2009. Results All of the sixteen patients were young women,and 15 of them were pregnant.Leukopenia was observed in 2 cases of the 16 patients,and lymphopenia in 14 cases.Data on the ratio of CD4 cells to CD8 cells were available for 12 patients,and 7 cases of whom had an abnormal CD4/CD8 ratio(<1.4).Eleven of the 15 patients had increased serum loactate dehydrogenase levels,which were above 245 U/L .Three patients had elevated creatine kinase levels at admission.Five cases of the 16 patients had decreased scram potassium levels.which were below 3.5 mmol/L. Four patients had C4 levels greater than 36 mg per deciliter,and 4 cases had C3 less than 75 mg per deciliter.All 16 patients had radiologically confirmed pneumonia with bilateral patchy alveolar opacities,affecting 3 or 4 lung quadrants.Findings on chest radiographs were consistent with acute respiratory distress syndrome in all patients requiring mechanical ventilation.A small amount of pleural effusion was found in 4 cages.and pericardial effusion was found in 1 of them.Respiratory distress requiring intubation and mechanical ventilation developed in 9 pregnant patients within the first 24 hours after admission,and 2 of them in the third trimester died.while 7 patients for whom pregnancy was timely terminated recovered. Conclusions Pregnant women with 2009 pandemic influenza A(H1N1)appear to have an increased risk of severe disease characterized by severe pneumonia and respiratory failure.Early anti-viral therapy,early termination of pregnancy,and timely mechanical ventilation may bring clinical benefits to pregnant patients.
