摘要
目的探讨导致严重甲型H1N1流感病毒感染并多脏器功能障碍的原因及降低其死亡率的救治措施。方法回顾分析上海交通大学附属第一人民医院危重病科于2009年9月救治成功的一例重型甲型H1N1流感病毒感染患者临床资料，35岁男性患者，体型肥伴，高热、咽痛、咳嗽伴进行性加重呼吸困难、难以纠正的低氧血症、低血压。患者进行了保护性肺通气策略及肺复张术、血管活性药物、限制性体液复苏、适当的激素、早期足量使用奥司他韦抗病毒、输注特殊抗病毒血浆以及抗凝等综合治疗。结果经过一个月救治，临床症状明显改善，氧分压在不吸氧的条件下为74mmHg，肺部CT提示仍有弥漫性问质改变，发病第三周出现神经肌病。结论重型甲型H1N1流感病毒感染可发生在既往身体健康的成年患者，肥胖是其高死亡率的独立危险因素。对重症患者应尽早采取综合救治措施以降低死亡率。
Objective To investigate the causes of severe H1N1 Flu with multiple organ dysfunction,and measures to reduce mortality. Method The data of the patient, who was diagnosed as severe H1N1 Flu and multiple organ dysfunction syndrome in First People＇ s Hospital Affiliated to Shanghai Jiaotong University in September 2009, were retrospectively analyzed. The patient was male, 35 year-old, obese, high fever, sore throat, cough, progressive dyspnea, severe hypoxemia and hypotension. Effective measures were carried out, including protective lung ventilation, recruitment maneuver, vasopressor support, limited fluid resuscitation, appropriate corticosteroid, antiviral plasma, anticoagulation and antiviral medicine （Oseltamivir）in early stage and full dose. Results After one-month intensive care, clinical symptoms was improved obviously, oxygen pressure reached 74 mmHg without oxygen supply. CT scan showed diffused interstitial change. Neuromyopathy developed at approximately 3 weeks after the onset of H1N1. Conclusions H1N1 Flu can develop in healthy adults, and obesity is one of the independent risk factors. Effective measures should be taken as soon as possible to reduce the mortality.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2009年第11期1128-1131,共4页
Chinese Journal of Emergency Medicine
关键词
H1N1流感病毒感染
多脏器功能障碍综合征
死亡率
Influenza A（H1N1 ） virus infection
Multiple organ dysfunction syndrome（MODS）
Mortality
