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[目的]探讨重症甲型H1N1流感典型病例的临床特征和诊治经验。[方法]对收治的重症甲型H1N1流感确诊病例采取积极的诊断与治疗措施。[结果]所有确诊重症甲型H1N1流感病例均有流感样症状,包括发热(腋下温度≥37.5℃)、咽痛、流涕、肌肉酸痛(100%);体温≥39℃并持续3d以上16例;咳嗽、咳痰19例,头痛、头昏11例;胸闷、气促10例;水样便腹泻或呕吐5例;神志淡漠或烦躁7例;肺部湿性哕音5例。20例继发肺炎或支气管炎,其中2例为重症肺炎;急性呼吸衰竭1例;多器官功能障碍综合症1例。所有患者咽拭子甲型H1N1病毒核酸检测均阳性;WBC正常11例,WBC减少(﹤5.0×109/L)7例,WBC增高(﹥10.0×109/L)5例;淋巴细胞(L)正常(0.8～5.0×109/L)17例,L减低(﹤0.8×109/L)5例;胸部CT斑片状浸润影19例,肺纹理增粗、紊乱3例;ECG正常16例;T波改变、ST-T压低7例。所有患者治疗时间7～15d,平均时间(7.6±2.3)d。所有病例体温正常大于3d,流感样症状消失,临床症状稳定。咽拭子甲型H1N1病毒核酸检测均阴性。所有患者均临床治愈。[结论]早期有效的诊断和治疗是降低重症甲型H1N1流感病死率的关键。
[Objective] To explore the clinical characteristics and diagnosis and treatment of typical cases of severe type A (H1N1) influenza. [Methods] The positive diagnosis and treatment of confirmed cases of severe H1N1 influenza were taken. [Results] All confirmed cases of influenza A (H1N1) influenza had flu-like symptoms, including fever (armpit temperature ≥37.5 ℃), sore throat, runny nose and muscle soreness (100%), body temperature ≥39 ℃ for more than 3d Cases; cough, sputum in 19 cases, headache, dizziness in 11 cases; chest tightness, shortness of breath in 10 cases; watery diarrhea or vomiting in 5 cases; indifference or irritability in 7 cases; lung wet 哕 tone in 5 cases. 20 cases of secondary pneumonia or bronchitis, of which 2 cases of severe pneumonia; acute respiratory failure in 1 case; multiple organ dysfunction syndrome in 1 case. All of the patients were positive for throat swab A (H1N1). WBC was normal in 11 cases, WBC decreased (<5.0 × 109 / L) in 7 cases, WBC increased (> 10.0 × 109 / L) There were 17 cases with normal (0.8 ~ 5.0 × 109 / L), 5 cases with L reduced (<0.8 × 109 / L), 19 cases with thoracic CT patch- T wave changes, ST-T depression in 7 cases. All patients treated for 7 ~ 15d, the average time (7.6 ± 2.3) d. All cases of normal body temperature greater than 3d, flu-like symptoms disappeared, the clinical symptoms were stable. Throat swabs H1N1 virus nucleic acid tests were negative. All patients were clinically cured. [Conclusion] Early and effective diagnosis and treatment are the key to reduce the mortality of severe type A (H1N1).