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目的:分析危重症甲型H1N1流感的临床特点、主要治疗措施及转归,以期对危重症甲型H1N1流感进行更有效的治疗。方法:采用回顾性方法分析8例危重症甲流患者的临床特点、相关指标及转归。结果:APACHEⅡ评分(19.0±7.8)分;死亡5例,其中4例死于呼吸衰竭;死亡病例血小板较治愈及好转病例低(χ2=8.000,P<0.05)。4例使用糖皮质激素,均死亡;6例行有创机械通气的患者中,5例因无创机械通气失败而改为有创机械通气;其中3例在有创机械通气时并发气压伤,均死亡。结论:危重症甲流患者病死率高,呼吸衰竭为主要死亡原因。对危重症甲流患者不主张使用糖皮质激素;对于出现呼吸衰竭须机械通气者,建议直接采用小潮气量、低PEEP的有创呼吸支持。
OBJECTIVE: To analyze the clinical features, major treatment measures and prognosis of severe and severe type A (H1N1) influenza in order to carry out more effective treatment of critically ill type A (H1N1) influenza. Methods: A retrospective analysis of 8 cases of critically ill patients with a clinical features, related indicators and outcome. Results: The APACHE Ⅱ score was (19.0 ± 7.8) points; 5 died, of which 4 died of respiratory failure. The death platelets were lower than those cured and improved (χ2 = 8.000, P <0.05). 4 patients were treated with glucocorticoid and all died. Of the 6 patients who underwent invasive mechanical ventilation, 5 were replaced by invasive mechanical ventilation due to the failure of non-invasive mechanical ventilation; 3 of them were complicated with barotrauma during invasive mechanical ventilation death. Conclusion: A case of critically ill patients with a high case fatality rate, respiratory failure as the main cause of death. A critically ill patients do not advocate the use of glucocorticoid; respiratory failure for mechanical ventilation, the proposed direct use of low tidal volume, low PEEP invasive respiratory support.