中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2010年
3期
164-165
,共2页
青海%流感病毒A型%甲型H1N1流感%重症%呼吸衰竭
青海%流感病毒A型%甲型H1N1流感%重癥%呼吸衰竭
청해%류감병독A형%갑형H1N1류감%중증%호흡쇠갈
Qinghai%Influenza A virus%Severe influenza A H1N1 subtype%Respiratory failure
目的 了解青海省重症甲型H1N1流感患者的特点.方法 回顾分析2009年9月4日至12月31日青海省传染病院收治的157例甲型H1N1流感患者中75例重症、危重症的流行特点、临床症状及体征、辅助检查及治疗情况.结果 10月14日开始出现首例重症患者,至12月31日共出现75例,占47.78%.75例患者中农牧区患者45例(占60.00%),城市患者30例;男48例,女27例;合并肺炎者53例(占70.67%);有基础疾病者41例(占54.67%),有发热者65例(占86.67%),咳嗽、咯痰63例(占84.00%),呼吸困难61例(占81.33%),以脑膜炎为主要表现者1例,以急性肺水肿、左心衰竭为主要表现者2例.外周血白细胞降低28例(占37.33%),心肌酶异常28例(占37.33%),血糖异常23例(占30.67%),凝血功能异常8例(占10.67%),血脂异常4例(占5.33%),C-反应蛋白增高51例(占68.00%).48例给予奥司他韦、27例给予军科奥韦抗病毒,27例给予低分子肝素钠抗凝,22例给予甲泼尼龙治疗,33例行无创机械通气治疗者中10例改用有创机械通气,首选二线抗生素并进行痰培养,对8例合并真菌感染者行抗真菌治疗.75例患者除1例死亡外,余均治愈.结论 青海省重症高峰来得较早,重症比例高;甲型H1N1流感患者易合并肺部疾病,病情进展迅速,易致呼吸衰竭、弥散性血管内凝血、多器官功能衰竭.
目的 瞭解青海省重癥甲型H1N1流感患者的特點.方法 迴顧分析2009年9月4日至12月31日青海省傳染病院收治的157例甲型H1N1流感患者中75例重癥、危重癥的流行特點、臨床癥狀及體徵、輔助檢查及治療情況.結果 10月14日開始齣現首例重癥患者,至12月31日共齣現75例,佔47.78%.75例患者中農牧區患者45例(佔60.00%),城市患者30例;男48例,女27例;閤併肺炎者53例(佔70.67%);有基礎疾病者41例(佔54.67%),有髮熱者65例(佔86.67%),咳嗽、咯痰63例(佔84.00%),呼吸睏難61例(佔81.33%),以腦膜炎為主要錶現者1例,以急性肺水腫、左心衰竭為主要錶現者2例.外週血白細胞降低28例(佔37.33%),心肌酶異常28例(佔37.33%),血糖異常23例(佔30.67%),凝血功能異常8例(佔10.67%),血脂異常4例(佔5.33%),C-反應蛋白增高51例(佔68.00%).48例給予奧司他韋、27例給予軍科奧韋抗病毒,27例給予低分子肝素鈉抗凝,22例給予甲潑尼龍治療,33例行無創機械通氣治療者中10例改用有創機械通氣,首選二線抗生素併進行痰培養,對8例閤併真菌感染者行抗真菌治療.75例患者除1例死亡外,餘均治愈.結論 青海省重癥高峰來得較早,重癥比例高;甲型H1N1流感患者易閤併肺部疾病,病情進展迅速,易緻呼吸衰竭、瀰散性血管內凝血、多器官功能衰竭.
목적 료해청해성중증갑형H1N1류감환자적특점.방법 회고분석2009년9월4일지12월31일청해성전염병원수치적157례갑형H1N1류감환자중75례중증、위중증적류행특점、림상증상급체정、보조검사급치료정황.결과 10월14일개시출현수례중증환자,지12월31일공출현75례,점47.78%.75례환자중농목구환자45례(점60.00%),성시환자30례;남48례,녀27례;합병폐염자53례(점70.67%);유기출질병자41례(점54.67%),유발열자65례(점86.67%),해수、각담63례(점84.00%),호흡곤난61례(점81.33%),이뇌막염위주요표현자1례,이급성폐수종、좌심쇠갈위주요표현자2례.외주혈백세포강저28례(점37.33%),심기매이상28례(점37.33%),혈당이상23례(점30.67%),응혈공능이상8례(점10.67%),혈지이상4례(점5.33%),C-반응단백증고51례(점68.00%).48례급여오사타위、27례급여군과오위항병독,27례급여저분자간소납항응,22례급여갑발니룡치료,33례행무창궤계통기치료자중10례개용유창궤계통기,수선이선항생소병진행담배양,대8례합병진균감염자행항진균치료.75례환자제1례사망외,여균치유.결론 청해성중증고봉래득교조,중증비례고;갑형H1N1류감환자역합병폐부질병,병정진전신속,역치호흡쇠갈、미산성혈관내응혈、다기관공능쇠갈.
Objective To observe clinical features of severe influenza A H1N1 in Qinghai Province.Methods The clinical data of 75 severe influenza A H1N1 patients were analyzed retrospectively in regard to common features,clinical symptoms,signs,laboratory data and treatments hospitalized in Qinghai Hospital for Infectious Diseases during September 4,2009 to December 31,2009.Results The first case with severe influenza A H1N1 was diagnosed on October 14,and up to 75 patients(47.78%)on December 31.Among 75 patients,45 patients were from rural areas(60.00%)and 30 patients were urbanites,48 patients were male,and 27 female.Fifty-three patients were complicated with pneumonia(70.67%)and 41 patients with pre-existing medical conditions(54.67%),65 patients with fever(86.67%),63 patients with cough and sputum(84.00%),61 patients with dyspnea(81.33%),1 patients with meningitis as the main manifestation,2 patients with acute pulmonary edema and left heart failure,28 patients with teucopenia (37.33%),28 patients with myocardial enzyme abnormalities(37.33%),23 patients with blood glucose abnormalities(30.67%),8 patients with coagulopathy(10.67 %),4 patients with lipid abnormalities (5.33%),51patients with increased C-reactive protein(68.00%).Forty-eight patients received oseltamivir,27 patients received anti-virus "Jun Ke Ao Wei" capsules.Low molecular weight heparin was given to 27 patients for anticoagulation,and 22 were treated with methylprednisolone.In 33 patients who underwent non-invasive mechanical ventilation,among them it was switched to invasive mechanical ventilation in 10 patients.Second-line antibiotics were used,and sputum culture was done.In 8 patients with fungal infection anti-fungal therapy was given.Except 1 patient out of 75 patients died,and the rest were cured.Conclusion In Qinghai Province,cases with influenza A H1N1 peaked early with relative high incidence of severe cases.Patients suffering from influenza A H1N1 are susceptible to pulmonary complications.The condition of patients rapidly deteriorate,and they are prone to develop respiratory failure,disseminated intravascular coagulation and multiple organ failure.
