中华传染病杂志
中華傳染病雜誌
중화전염병잡지
CHINESE JOURNAL OF INFECTIOUS DISEASES
2014年
12期
735-739
,共5页
黄煌%潘越峻%张文先%王建%蔡卫平%张复春%尹炽标%邓西龙
黃煌%潘越峻%張文先%王建%蔡衛平%張複春%尹熾標%鄧西龍
황황%반월준%장문선%왕건%채위평%장복춘%윤치표%산서룡
H7N9禽流感%呼吸窘迫综合征,成人%危险因素%治疗
H7N9禽流感%呼吸窘迫綜閤徵,成人%危險因素%治療
H7N9금류감%호흡군박종합정,성인%위험인소%치료
H7N9 avian influenza%Respiratory distress syndrome,adult%Risk factors%Treatment
目的 了解人感染H7N9禽流行性感冒(流感)重症病例的临床特征和危险因素,提高对重症病例诊治的认识.方法 对广州市第八人民医院2014年1月至5月确诊的17例人感染H7N9禽流感患者的临床资料,包括基础疾病、禽类接触史、入院时病情严重程度、临床表现、实验室检查、影像学特征、并发症、治疗及转归等进行回顾性分析.计量资料采用t检验,计数资料采用x2检验(或Fisher确切概率法);非正态数据采用Mann-WhitneyU检验.结果 17例患者年龄4～88岁,平均53岁.存活11例,死亡6例.其中有11例存在基础疾病,合并两种以上基础疾病者6例.14例为重症病例.存活组患者氧合指数明显高于死亡组[(196.4±100.3)mmHg(1 mmHg=0.133 kPa)比(78.3±27.9) mmHg,t=-3.523,P=0.004],入院时急性生理与慢性健康评分Ⅱ(APACHEⅡ)死亡组患者评分明显高于存活组(28.8±4.6比15.4±7.6,t=-3.955,P=0.001).入院检查所有重症患者均有不同程度的淋巴细胞及CD4+T淋巴细胞计数减少,存活组患者CD4+T淋巴细胞计数明显高于死亡组(t=2.378,P=0.031).住院治疗过程中共有6例患者痰(肺泡灌洗液)培养病原学结果阳性,其中3例培养出鲍曼不动杆菌、白念珠菌、耐甲氧西林金黄色葡萄球菌(MRSA)、肺炎克雷伯菌、耐甲氧西林溶血葡萄球菌(MRSH)等多种病原体.17例患者均接受抗病毒治疗.14例重症患者入住ICU,均需机械通气治疗,其中7例患者予无创辅助通气,7例患者需有创通气支持;3例重度急性呼吸窘迫综合征(ARDS)患者予俯卧位通气治疗后氧合指数明显改善.结论 高龄、有基础疾病是H7N9感染病例发展为重症的主要危险因素,重症病例主要表现为呼吸衰竭和免疫功能损害,容易继发细菌感染、感染性休克和多器官功能障碍综合征.多数病例需要ICU的综合救治,机械通气是主要救治措施,其中俯卧位通气可明显改善重症ARDS患者的氧合.
目的 瞭解人感染H7N9禽流行性感冒(流感)重癥病例的臨床特徵和危險因素,提高對重癥病例診治的認識.方法 對廣州市第八人民醫院2014年1月至5月確診的17例人感染H7N9禽流感患者的臨床資料,包括基礎疾病、禽類接觸史、入院時病情嚴重程度、臨床錶現、實驗室檢查、影像學特徵、併髮癥、治療及轉歸等進行迴顧性分析.計量資料採用t檢驗,計數資料採用x2檢驗(或Fisher確切概率法);非正態數據採用Mann-WhitneyU檢驗.結果 17例患者年齡4～88歲,平均53歲.存活11例,死亡6例.其中有11例存在基礎疾病,閤併兩種以上基礎疾病者6例.14例為重癥病例.存活組患者氧閤指數明顯高于死亡組[(196.4±100.3)mmHg(1 mmHg=0.133 kPa)比(78.3±27.9) mmHg,t=-3.523,P=0.004],入院時急性生理與慢性健康評分Ⅱ(APACHEⅡ)死亡組患者評分明顯高于存活組(28.8±4.6比15.4±7.6,t=-3.955,P=0.001).入院檢查所有重癥患者均有不同程度的淋巴細胞及CD4+T淋巴細胞計數減少,存活組患者CD4+T淋巴細胞計數明顯高于死亡組(t=2.378,P=0.031).住院治療過程中共有6例患者痰(肺泡灌洗液)培養病原學結果暘性,其中3例培養齣鮑曼不動桿菌、白唸珠菌、耐甲氧西林金黃色葡萄毬菌(MRSA)、肺炎剋雷伯菌、耐甲氧西林溶血葡萄毬菌(MRSH)等多種病原體.17例患者均接受抗病毒治療.14例重癥患者入住ICU,均需機械通氣治療,其中7例患者予無創輔助通氣,7例患者需有創通氣支持;3例重度急性呼吸窘迫綜閤徵(ARDS)患者予俯臥位通氣治療後氧閤指數明顯改善.結論 高齡、有基礎疾病是H7N9感染病例髮展為重癥的主要危險因素,重癥病例主要錶現為呼吸衰竭和免疫功能損害,容易繼髮細菌感染、感染性休剋和多器官功能障礙綜閤徵.多數病例需要ICU的綜閤救治,機械通氣是主要救治措施,其中俯臥位通氣可明顯改善重癥ARDS患者的氧閤.
목적 료해인감염H7N9금류행성감모(류감)중증병례적림상특정화위험인소,제고대중증병례진치적인식.방법 대엄주시제팔인민의원2014년1월지5월학진적17례인감염H7N9금류감환자적림상자료,포괄기출질병、금류접촉사、입원시병정엄중정도、림상표현、실험실검사、영상학특정、병발증、치료급전귀등진행회고성분석.계량자료채용t검험,계수자료채용x2검험(혹Fisher학절개솔법);비정태수거채용Mann-WhitneyU검험.결과 17례환자년령4～88세,평균53세.존활11례,사망6례.기중유11례존재기출질병,합병량충이상기출질병자6례.14례위중증병례.존활조환자양합지수명현고우사망조[(196.4±100.3)mmHg(1 mmHg=0.133 kPa)비(78.3±27.9) mmHg,t=-3.523,P=0.004],입원시급성생리여만성건강평분Ⅱ(APACHEⅡ)사망조환자평분명현고우존활조(28.8±4.6비15.4±7.6,t=-3.955,P=0.001).입원검사소유중증환자균유불동정도적림파세포급CD4+T림파세포계수감소,존활조환자CD4+T림파세포계수명현고우사망조(t=2.378,P=0.031).주원치료과정중공유6례환자담(폐포관세액)배양병원학결과양성,기중3례배양출포만불동간균、백념주균、내갑양서림금황색포도구균(MRSA)、폐염극뢰백균、내갑양서림용혈포도구균(MRSH)등다충병원체.17례환자균접수항병독치료.14례중증환자입주ICU,균수궤계통기치료,기중7례환자여무창보조통기,7례환자수유창통기지지;3례중도급성호흡군박종합정(ARDS)환자여부와위통기치료후양합지수명현개선.결론 고령、유기출질병시H7N9감염병례발전위중증적주요위험인소,중증병례주요표현위호흡쇠갈화면역공능손해,용역계발세균감염、감염성휴극화다기관공능장애종합정.다수병례수요ICU적종합구치,궤계통기시주요구치조시,기중부와위통기가명현개선중증ARDS환자적양합.
Objective To investigate the clinical characteristics and risk factors of patients with avian influenza A H7N9 virus severe infection,and to improve cognition of diagnosis and treatment for severe cases.Methods Data were collected and analyzed retrospectively from 17 patients with confirmed avian influenza A H7N9 virus infection admitted to Guangzhou Eighth People's Hospital between January and May 2014,including underlying diseases,exposure history,illness severity on admission,clinical manifestations,laboratory examinations,imaging features,complications,treatment,the period of hospitalization and outcomes.Univariate analysis was performed using chi-square tests (or Fisher's exact tests) for binary outcomes and student t-tests for normally distributed outcomes or Mann-Whitney U test for non-normally distributed outcomes.Results The average age of 17 patients were 53 (4-88) years old.Among them,11 patients survived and 6 patients died.Eleven cases had underlying diseases and 6 cases had two or more than two underlying diseases.Fourteen cases were severe infection.Oxygenation index were significantly higher in the survive group compared with the death group ([196.4± 100.3] mmHg vs [78.3±27.9] mmHg,t=-3.523,P=0.004).Average acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score in the survive group was 15.4±7.6,which was significantly lower than the death group (28.8±4.6,t=-3.955,P=0.001).The lymphocytes and CD4+ T lymphocyte count decreased in all severe cases,but CD4+ T lymphocyte count in the survive group was significantly higher than the death group (t =2.378,P =0.031).Sputum (bronchoalveolar lavage fluid) cultures from 6 patients were positive,including 3 of Acinetobacter baumanii,Albicans saccharomyces,methicillin resistant Staphylococcus aureus (MRSA),Klebsiella pneumoniae and methicillin resistant Staphylococcus haemolyticus (MRSH).Antiviral therapy was administered for all the 17 patients.Fourteen severe cases were admitted to intensive care units and required mechanical ventilation,of which 7 patients with noninvasive ventilation and 7 patients with invasive ventilation.Three cases with severe acute respiratory distress syndrome (ARDS) were treated with the prone positioning during mechanical ventilation,and oxygenation index improved significantly after treatment.Conclusions Elderly and underlying diseases are the major risk factors for patients with severe H7N9 infection.Most severe cases show respiratory failure and immunosuppression,leading to secondary bacterial infections,septic shock and multiple organ dysfunction syndrome.Most severe cases require intensive care.Mechanical ventilation is the main treatment measures,and prone positioning can significantly improve oxygenation in patients with severe ARDS in short time.
