CAJ | 학술논문

目的：了解妊娠合并甲型H1 N1流感（甲流）危重症患者的临床特点，探讨甲流对患者的长期影响。方法选取2009年11月—2010年2月中国医科大学附属盛京医院收治的妊娠合并甲流危重症患者7例，收集其临床资料，分析住院期间疾病严重程度及肺部影像特点，并在出院后1、5年进行门诊随访，观察临床症状、胸部CT表现及肺功能指标变化情况。另外对存活新生儿进行临床症状及生长发育测评随访。结果7例危重症患者年龄为22～39岁，平均为27.3岁；孕周为22～38＋6周，平均为32周；均选择了剖宫产终止妊娠，其中死亡2例，存活5例。5例存活患者气管插管时间为5～21 d，平均为13.6 d；住院时间为4～35 d，平均为19.4 d。5例存活患者随访1年后，有2例存在临床慢性呼吸道症状，胸部CT异常3例，肺弥散功能异常5例，合并小气道功能异常3例；随访5年后，仍有2例存在临床慢性呼吸道症状，胸部CT异常3例，肺弥散功能异常5例，合并小气道功能异常1例。3例存活新生儿孕周为34＋2～35＋1周，平均为34.5周；体质量为1380～2120 g，平均为1881 g；未发现H1N1流感病毒感染；在随访1、5年中，生长发育与其他婴幼儿无异。结论妊娠合并甲流危重症患者出院1、5年后，胸部CT异常和肺功能障碍仍较为常见，应重视对此类患者的实验室检查以及长期随访。
목적：료해임신합병갑형H1 N1류감（갑류）위중증환자적림상특점，탐토갑류대환자적장기영향。방법선취2009년11월—2010년2월중국의과대학부속성경의원수치적임신합병갑류위중증환자7례，수집기림상자료，분석주원기간질병엄중정도급폐부영상특점，병재출원후1、5년진행문진수방，관찰림상증상、흉부CT표현급폐공능지표변화정황。령외대존활신생인진행림상증상급생장발육측평수방。결과7례위중증환자년령위22～39세，평균위27.3세；잉주위22～38＋6주，평균위32주；균선택료부궁산종지임신，기중사망2례，존활5례。5례존활환자기관삽관시간위5～21 d，평균위13.6 d；주원시간위4～35 d，평균위19.4 d。5례존활환자수방1년후，유2례존재림상만성호흡도증상，흉부CT이상3례，폐미산공능이상5례，합병소기도공능이상3례；수방5년후，잉유2례존재림상만성호흡도증상，흉부CT이상3례，폐미산공능이상5례，합병소기도공능이상1례。3례존활신생인잉주위34＋2～35＋1주，평균위34.5주；체질량위1380～2120 g，평균위1881 g；미발현H1N1류감병독감염；재수방1、5년중，생장발육여기타영유인무이。결론임신합병갑류위중증환자출원1、5년후，흉부CT이상화폐공능장애잉교위상견，응중시대차류환자적실험실검사이급장기수방。
Objective To investigate the clinical features of critically ill patients with influenza A H 1N1 during pregnancy and long -term influence of influenza A H1N1 on gestational patients.Methods We enrolled 7 patients with influenza A H1N1 during pregnancy who were admitted into Shengjing Hospital of China Medical University from December 2009 to February 2010.Clinical data were collected , and the severity of illness and lung imaging characteristics during hospitalization were analyzed.Outpatient follow-up visits were conducted in 1 year and 5 years after discharge , during which clinical symptoms , chest CT manifestations and changes of pulmonary indicators were observed.We also examined the clinical symptoms , growth and development of surviving newborns.Results The 7 patients aged from 22 to 39 years old, with an average age of 27.3; their number of gestational weeks were 22~38+6 , averagely 32; all the 7 patients chose caesarean section to end gestation , among which 2 patients died and 5 patients survived.The intubation time of the 5 surviving patients was 5~21 d, averagely 13.6 d; the length of hospitalization was 4~35 d, averagely 19.4 d.One year after discharge , among the 5 surviving patients , 2 patients had chronic respiratory symptoms , 3 patients had abnormity in chest CT , 5 patients had abnormality of diffuse pulmonary function , and 3 patients had the complication of small airway dysfunction; five years after discharge , among the 5 surviving patients , 2 patients had chronic respiratory symptoms , 3 patients had abnormity in chest CT , 5 patients had abnormality of diffuse pulmonary function , and 1 patients had the complication of small airway dysfunction.For the 3 surviving newborns , the number of gestational weeks of was 34 +2 ~35+1 , averagely 34.5; their body mass ranged from 1 380 g to 2 120 g, averagely 1 881 g; no influenza A H1N1 was noted; and no differences were detected in the growth and development during 1-year and 5-year follow-up visits, compared with other infants.Conclusion In 1 year and 5 years after the discharge of critical patients with influenza A H 1N1 during pregnancy , abnormality in chest CT and pulmonary dysfunction are common , thus clinical examination and long -term follow-up on the patients should be attached importance.