呼吸机支持治疗的危重症甲型H1N1流感20例分析(1)
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【摘要】 目的 总结危重症甲型H1N1流感诊治过程中的经验与教训。方法 对本院2009年10月～2010年1月在我院确诊并在呼吸监护病房(RICU)进行呼吸机支持治疗的危重症甲型H1N1流感患者的病历资料进行回顾分析及文献学习。 结果 20例患者,均为确诊病例,病毒核酸检查为阳性,15例第一次病毒核酸检测即为阳性,5例第一次阴性,第二次病毒核酸检测阳性确诊。其中孕妇13例,年龄23～33(平均28)岁,孕28～37(平均32)周。肾衰患者1例,男,66岁。慢性淋巴细胞性白血病1例,男,30岁。慢性阻塞性肺疾病4例,均为男性,年龄66～81(平均70)岁。营养不良1例,男,29岁。20例均不同程度出现肺间质损害, 后遗轻度肺间质纤维化者17例,后遗严重肺间质纤维化者3例。20例全部应用呼吸机辅助通气治疗,17例应用静注人血丙种球蛋白进行治疗,无死亡病例。结论 20例患者诊断上均符合一般病毒性肺炎的特点,仅一次病毒核酸检查阴性不能排除甲型H1N1流感,再次检查可得阳性结果。20例患者,均不同程度出现肺间质损害, 治疗上尽早应用静注人血丙种球蛋白治疗,早期应用者,预后好,后遗症轻微。孕妇均应及时终止妊娠,终止妊娠手术时进行呼吸支持应使用带有呼吸末正压(PEEP)的呼吸机或麻醉机,设置PEEP压力在10cmH2O以上水平,按ARDS治疗原则,对患者进行高PEEP呼吸支持才能保障手术安全进行。
【关键词】危重症 甲型H1N1流感 呼吸机治疗
中国分类号:R511.7文献标识号:A 文章编号:1005-0515(2010)10-013-03
【Abstract Objective】 To summarize the Critically ill diagnosis and treatment of influenza A H1N1 in the process of experiences and lessons learned. MethodsClinical data of 20 influenza A H1N1 patients, treated in the respiratory intensive care unit(RICU) in our hospital from October 2009 to January2010, were studied retrospectively with literature review. Results 20 patients, were confirmed cases, the virus nucleic acid checking positive, 15 cases for the first time the virus nucleic acid testing shall be positive, five cases of the first negative, the second confirmed positive for the virus nucleic acid testing. In which 13 cases of pregnant women, aged 23 to 33 (average 28) years old, pregnant 28 ~ 37 (mean 32) weeks. Patients with renal failure in 1 case, male,66 years. 1 case of chronic lymphocytic leukemia, male, 30 years old. Chronic obstructive pulmonary disease, 4 cases were male, aged 66 to 81 (average 70) years old. 1 case of malnutrition, male, 29 years old. 20 cases there were varying degrees of interstitial lung damage, the aftermath of mild pulmonary interstitial fibrosis in 17 cases, the aftermath of severe pulmonary interstitial fibrosis in 3 patients. All 20 cases of application of ventilator-assisted ventilation therapy, 17 cases of human blood, use of intravenous gamma globulin treatment, no death cases ......
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