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目的分析甲型H1N1流感重症病例的临床特点,并对其诊治方法进行探讨。方法对2009年11月13日—12月24日河北医科大学附属哈励逊国际和平医院收治的40例甲型H1N1流感重症病例的临床症状、实验室检查、影像学特点及治疗转归情况进行回顾性分析。结果 40例患者中男14例,女26例,年龄1～68岁,平均26.5岁。仅1例有明确接触史,平均潜伏期平均3.6d;34例以发热为首发症状,所有患者均以发热、咳嗽为主要症状,肺部均可闻及湿性啰音笛槭壹觳?40.0%的患者白细胞计数升高,17.5%的患者白细胞计数降低;27.5%的患者乳酸脱氢酶水平有不同程度升高。胸部X线片及肺CT检查主要表现为肺叶或间质炎症浸润影。出现急性呼吸窘迫综合征(ARDS)13例,2例死亡。结论甲型H1N1流感诊疗的关键是早期识别重症病例,并及时给予奥司他韦治疗、综合支持治疗可取得较好的疗效。
Objective To analyze the clinical features of severe cases of Influenza A (H1N1) and to discuss its diagnosis and treatment. Methods The clinical symptoms, laboratory tests, imaging features and treatment outcomes of 40 severe cases of Influenza A (H1N1) in Hileun International Peace Hospital affiliated to Hebei Medical University from November 13 to December 24, 2009 were retrospectively analyzed. Retrospective analysis. Results 40 patients were male and 14 females, 26 females, aged 1 to 68 years, mean 26.5 years. Only one case had a clear history of exposure, with an average incubation period of 3.6 days on average. In the 34 patients with fever as the first symptom, all patients had fever and cough as the main symptoms, lungs could be heard and wet rales. Of patients with elevated white blood cell count, 17.5% of patients with lower white blood cell count; 27.5% of patients with varying degrees of lactate dehydrogenase levels. Chest X-ray and pulmonary CT examination showed mainly lobular or interstitial inflammatory infiltrates. There were 13 cases of acute respiratory distress syndrome (ARDS) and 2 died. Conclusion The key to the diagnosis and treatment of Influenza A (H1N1) is early identification of severe cases, and the timely administration of oseltamivir, comprehensive supportive care can achieve better results.