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目的:分析22例重症甲型H1N1流感合并两肺弥漫性肺炎患者的临床资料,总结临床抢救体会。方法:回顾分析收治的22例重症甲型H1N1合并两肺弥漫性肺炎患者的临床资料进行。结果:22例患者年龄39.9±12.7岁,临床症状以发热、咳嗽、胸痛、呼吸困难及低氧血症为主要特征,部分患者出现消化道症状、休克;外周血白细胞计数较正常值偏低,X线胸片或胸部CT提示双侧广泛性或多肺叶性的弥漫性病变;22例患者均给予抗病毒治疗(奥司他韦75mg或150mg,每日2次口服),全部患者均应用激素治疗,甲基强的松龙80~240mg.d-1,平均治疗剂量为136.4±58.8mg.d-1,14例患者采用无创机械通气治疗,2例患者经气管插管行机械通气治疗,2例患者死亡。结论:重症甲型H1N1流感合并两肺弥漫性肺炎患者临床症状进展快、病情重,需尽早应用抗病毒药物、合理地应用全身性糖皮质激素等治疗,同时予积极合理地氧疗,机械通气能增强氧疗的效果、迅速改善病情、改善预后。
Objective: To analyze the clinical data of 22 patients with severe type A (H1N1) influenza complicated with diffuse pneumonia and summarize the experience of clinical rescue. Methods: Retrospective analysis of 22 patients with severe type A H1N1 pulmonary diffuse pneumonia in patients with clinical data. Results: Twenty-two patients were 39.9 ± 12.7 years old. The main clinical symptoms were fever, cough, chest pain, dyspnea and hypoxemia. Some patients had gastrointestinal symptoms and shock. The peripheral blood leukocyte count was lower than normal, X-ray or chest CT showed bilateral extensive or multilobar diffuse lesions; 22 patients were given antiviral therapy (oseltamivir 75mg or 150mg, 2 times a day orally), all patients were treated with hormones Treatment, methylprednisolone 80 ~ 240mg.d-1, the average therapeutic dose was 136.4 ± 58.8mg.d-1, 14 patients were treated with noninvasive mechanical ventilation, 2 patients were treated by endotracheal intubation mechanical ventilation, Two patients died. Conclusion: The clinical symptoms of severe H1N1 influenza in patients with diffuse pneumonia of both lungs are progressing fast and their condition is serious. Antiviral drugs should be used as early as possible and the systemic glucocorticoid therapy should be used reasonably. At the same time, positive and reasonable oxygen therapy and mechanical ventilation Can enhance the effect of oxygen therapy, rapid improvement of the condition, improve the prognosis.