Sixty-two severe and critical patients with 2009 influenza A (H1N1) in Shanghai, China
Sixty-two severe and critical patients with 2009 influenza A (H1N1) in Shanghai, China
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DOI：
10.3760/cma.j.issn.0366-6999.2011.11.011
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发表时间：
2011-06-05
影响因子：
6.1
通讯作者：
Zhang Zhi-yong
中科院分区：
文献类型：
--
作者：
Liu Li;Zhang Ren-fang;Zhang Zhi-yong
背景2009年5月，甲型H1N1流感大流行在中国迅速出现。与季节性流感的初步比较表明，2009年甲型H1N1流感大流行对年轻人的影响不成比例，通常引起轻微疾病。方法回顾性分析2009年上海市公共卫生临床中心收治的62例甲型H1N1流感（H1N1）重症和危重症患者的病情进展、合并症和治疗结果。收集人口统计学数据，症状，合并症，疾病进展，治疗和临床outcomes.Results分析62例重症或危重症患者入院确诊为2009年甲型H1N1流感（H1N1）感染。研究队列的中位年龄为40岁，范围为18岁至75岁，67.7%为男性。所有患者均出现发热和呼吸道症状。就诊时，34例患者（54.8%）有合并症，如吸烟（29.0%）、高血压（29.0%）和B型肝炎病毒感染（9.7%）。从症状发作到入院的中位时间为6天（四分位距3-14天），23例危重患者入院后进入重症监护室。所有患者均接受神经氨酸酶抑制剂（奥司他胺）治疗，60例（96.7%）患者接受抗生素治疗，39例（62.9%）患者接受皮质类固醇治疗。23例危重患者入院第1天即行无创机械通气，其中3例最终需行有创通气。4例（6.5%）死亡病例发生在发病后14 d内，主要死因为严重急性呼吸窘迫综合征、低氧血症或并发症、继发感染和败血症、脓气胸和脑卒中。危重病例与严重低氧血症、多系统器官衰竭和需要机械通气相关。大多数患者预后良好。中华医学杂志2011;124（11）：1662-1666
Background Pandemic influenza A (H1N1) emerged rapidly in China in May 2009. Preliminary comparisons with seasonal influenza suggest that pandemic 2009 influenza A (H1N1) disproportionately affects younger ages and causes generally mild disease. To characterize disease progress, comorbidities, and treatment outcomes among consecutive severe and critically ill patients in a hospital served as a reference center for the care of patients with H1N1 in Shanghai, China.Methods A retrospective study on 62 severe and critically ill patients with 2009 influenza A (H1N1) was conducted in Shanghai Public Health Clinical Center. Demographic data, symptoms, comorbidities, disease progression, treatments, and clinical outcomes were collected for analysis.Results Sixty-two severe or critically ill patients were admitted to the hospital with confirmed 2009 influenza A (H1N1) infection. The median age of the study cohort was 40 years old with a range from 18 years to 75 years, and 67.7% were males. All patients presented with fever and respiratory symptoms. At presentation, 34 patients (54.8%) had comorbidities such as smoking (29.0%), hypertension (29.0%) and hepatitis B virus infection (9.7%). The median time from symptom onset to hospital admission was 6 days (interquartile-range 3-14 days) and 23 critically ill patients were admitted to Intensive Care Unit after admission. All the patients received neuraminidase inhibitors (oseltaminir), while 60 patients (96.7%) were treated with antibiotics, and 39 (62.9%) with corticosteroids. Twenty-three critical cases received noninvasive mechanical ventilation on the first day of admission, and 3 of them ultimately required invasive ventilation. Four death reports (6.5%) were filed within the first 14 days from the onset of critical illness with the primary causes of severe acute respiratory distress syndrome, hypoxemia, or complications, secondary infection and sepsis, pyopneumothorax and stroke.Conclusions Severe illness from 2009 influenza A (H1N1) infection in Shanghai occurred among young individuals. Critical cases were associated with severe hypoxemia, multisystem organ failure, and a requirement for mechanical ventilation. Most patients had a good prognosis. Chin Med J 2011;124(11):1662-1666