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目的探索孕产妇甲型H1N1流感危重型病例的临床特点及诊治经验。方法深圳市首例甲型H1N1流感危重症孕产妇患者,应用奥司他韦和扎那米韦联合抗病毒治疗,早期机械辅助通气、抗菌药物、糖皮质激素、对症支持等综合治疗。采用荧光定量RT-PCR评价抗病毒治疗效果,动态放射学检查、血气分析、血常规和生化检查监测病情变化。结果该孕产妇以高热、咳嗽、呼吸困难为主要症状,3d后进展为重症肺炎,合并急性呼吸窘迫综合征(ARDS)。联合抗病毒治疗后,患者体内的病毒在短期内得到有效控制和清除;抗菌药物有效控制细菌感染;机械通气、激素及其他对症支持治疗有效控制了ARDS。结论孕产妇甲型H1N1流感病情重、进展快,易合并ARDS为其主要临床特征。早期迅速清除病毒、及时正确的机械通气、选择有效抗菌药物控制继发细菌感染是治疗成功的关键。激素类药物的使用值得进一步探索。
Objective To explore the clinical features, diagnosis and treatment of critically ill cases of influenza A (H1N1) in pregnant women. Methods The first case of pregnant women with severe H1N1 influenza in Shenzhen was treated with combination of oseltamivir and zanamivir, early mechanical ventilation, antimicrobial drugs, glucocorticoids and symptomatic support. Fluorescent quantitative RT-PCR was used to evaluate the effect of antiviral therapy, dynamic radiological examination, blood gas analysis, blood tests and biochemical tests to monitor the changes of the disease. Results The pregnant women with high fever, cough, dyspnea as the main symptoms, progressive severe pneumonia 3d, combined with acute respiratory distress syndrome (ARDS). After combined antiviral therapy, the virus in the patient’s body can be effectively controlled and cleared within a short period. Antibacterials can effectively control the bacterial infection. Mechanical ventilation, hormones and other symptomatic supportive therapies effectively control ARDS. Conclusion The pregnant women with swine influenza A (H1N1) are seriously ill and rapidly progressing. ARDS is the main clinical feature. Early rapid removal of the virus, timely and correct mechanical ventilation, the choice of effective antibacterial drugs to control secondary bacterial infection is the key to the success of treatment. The use of hormonal drugs deserves further exploration.