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目的:探讨住院甲型H1N1流感重症病例的基本临床特征、治疗和结局。方法:回顾性分析2009年5月至2010年4月入住我院的39例甲型H1N1流感重症患者的临床资料。结果:平均发病年龄18.4岁;存在慢性基础疾病者5例,入院初始平均APACHEⅡ评分9.3分,第1日胸部X线影像学检查有11例存在双侧肺感染病灶;危重病例17例,均存在低氧血症,循环衰竭也较常见,还有部分患者出现脏器功能障碍综合征。所有患者均用抗病毒治疗(达菲),其中8例行机械通气治疗,7例应用血管活性药物,1例给予了ECMO治疗。所有患者中有4例死亡,其14、28和60d后病死率分别为7.7%、7.7%和10.3%。死亡者与存活者间的比较,起病到开始服用奥司他韦的时间和疗程较长。结论:甲型H1N1流感重症患者青少年及儿童居多,多数预后良好;如病情进展迅速则主要表现为呼吸衰竭和多脏器功能障碍综合征,及时的抗病毒治疗、机械通气和循环支持治疗可以减慢疾病进展和改善预后。
Objective: To investigate the basic clinical features, treatment and outcome of severe cases of influenza A (H1N1) in hospital. Methods: The clinical data of 39 cases of severe H1N1 influenza admitted to our hospital from May 2009 to April 2010 were retrospectively analyzed. Results: The average age of onset was 18.4 years old. There were 5 cases of chronic basic disease, the average initial admission APACHEⅡ score of 9.3 points, the 1st day of chest X-ray imaging examination of 11 cases of bilateral lung infection and the critical cases of 17 cases Hypoxemia, circulatory failure are more common, there are some patients with organ dysfunction syndrome. All patients were treated with antiviral therapy (Tamiflu), of which 8 received mechanical ventilation, 7 received vasoactive drugs and 1 received ECMO. Four of all patients died, with a post-mortem rate of 7.7%, 7.7% and 10.3% after 14, 28 and 60 days, respectively. Comparison of death and survivors, onset and start taking oseltamivir longer and longer course of treatment. Conclusion: The majority of children and adolescents with severe influenza A (H1N1) are most likely to have prognosis. Most patients with severe H1N1 influenza have good prognosis. If their disease progresses rapidly, they are mainly respiratory failure and multiple organ dysfunction syndrome, timely antiviral therapy, and mechanical ventilation and circulatory supportive care can be reduced Slow disease progression and improve prognosis.