32例无基础疾病者甲型H1N1流感危重症特点分析

摘要

目的 了解无基础疾病者感染甲型H1N1流感危重症的临床特点、治疗和转归.方法 观察北京地坛医院2009年10月3日-12月31日收治的32例无基础疾病者感染甲型H1N1流感危重症的临床特点、主要治疗和转归.结果 危重症易发生于65岁以下(96.9％)及肥胖者(71.0％).甲型H1N1流感危重症临床特点为高热(96.9％)、呼吸困难(93.8％)、双肺可闻及干湿性啰音(93.8％)、咳血痰(62.5％),部分出现呕吐或腹泻(25.0％).入院时均有低氧血症[氧合指数为(157.7±65.5)mmHg],25例并发急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS),3例在发病早期并发多脏器功能障碍(multiple organ dysfunction syndrome,MODS),14例继发感染(包括细菌感染和真菌感染).所有患者均接受磷酸奥司他韦治疗,开始使用平均病日为(5.4±2.6)d(中位数5d)；26例(81.3％)住ICU治疗,入住ICU时平均病日为(5.5±2.1)d,ICU治疗天数为(10.5±8.1)d；23例(71.9％)接受机械通气治疗,12例(37.5％)接受有创呼吸支持,有创呼吸支持开始平均病日为(6.2±4.0)d,其中1例使用体外膜肺氧合治疗.4例死亡,死亡原因为ARDS(3例)和感染性休克(1例).结论 甲型H1N1流感危重症病例多发生于中青年及肥胖人群.危重症病例均发展为严重低氧血症,部分早期出现MODS,大部分须住ICU,且须机械通气治疗.%Objective To investigate clinical characteristics, treatment, and outcome of critically ill patients with pandemic 2009 influenza A (H1N1) unaccompanied by underlying diseases. Method Clinical features, treatment protocols and outcome of 32 critically ill patients with pandemic 2009 influenza A (H1N1) unaccompanied by underlying diseases, who were treated in Beijing Ditian Hospital from Oct. 3 to Dec. 31, 2009, were analyzed. Results Critical illness was more commonly seen in patients under the age of 65 (96.9%) and those with obesity (71.0%). The main clinical features were high fever (96.9%), dyspnea (93.8%), dry or moist rales audible in both lungs (93.8%), hemoptysis (62.5%), and diarrhea or vomiting (25.0%). At hospital admission, all the patients had hypoxemia (mean ratio of PaO2 to fraction of inspired oxygen 157.7±65.5 mmHg), 25 patients were complicated by acute respiratory distress syndrome (ARDS), 3 by multiple organ dysfunction syndrome (MODS) in the early stage of onset and 14 had secondary infections in cluding bacterial and fungal infections. All of the patients received oseletamivir, which was administered at day 5.4 ±2.6 (median time 5 days) from onset Twenty-six patients were admitted to intensive care unit (ICU), the mean admission time from onset was 5.5±2.1 days, and the duration of ICU stay was 10.5±8.1 days. Twenty-three patients (71.9%) were given mechanical ventilation, 12 (37.5%) of whom received invasive respiratory support, which started at day 6.2±4.0 from onset, and 1 received extracorporeal membrane oxy genation. Four patients died as a result of ARDS (3 patients) or septic shock (1 patient). Conclusions Critical illness due to 2009 influenza A (H1N1) is more commonly seen in young and middle-aged adults and obesity population. All the critically ill patients with influenza A (H1N1) develop severe hypoxemia. Part of them develop MODS at the early stage of onset, and most need to be admi tted to ICU and receive mechanical ventilation.