【作者】 佟鑫；

【导师】 徐建国；

【作者基本信息】 吉林大学 ， 临床医学， 2010， 硕士

【摘要】 2009年初始,墨西哥开始出现呼吸道疾病疫情,一种新型人类甲型流感病毒H1N1毒株在墨西哥被分离出来,后被证实是由新型猪源性流感病毒A(H1N1)-(S-OIV)所引起,称为“人感染猪流感”,随着研究的逐步深入及对该疾病的不断认知,世界卫生组织(WHO)将其更名为“甲型H1N1流感”,同时把这一病毒的流行定义为国际性的公共卫生事件,仅在短短的几个月之内流行级别就被迅速提升至6级,虽其病死率明显低于之前同样全球大范围流行的传染性非典型肺炎(SARS)及禽流感(Bird Flu),但却有较强的人群普遍易感性及传染性。目前对新发出现的甲型H1N1流感病毒的研究仍处于早期阶段,我国尤其如此,尚需相关实验室研究加以了解,并不断进行临床大规模的病例统计,从而总结其发病特点及诊治等规律,这样既能早期发现、早期诊断、早期治疗,进而有效的防治此次大流行的继续蔓延,同时也对今后爆发流感的控制提供参考指导,有利于流行性传染性疾病预防工作的开展。本文对2009年10月至2009年12月于我院收治的30例确诊为甲型H1N1流感,并有相关住院资料的患者进行病例回顾性分析。从患者的流行病学特征、临床表现特点、实验室检查、影像学改变及诊治、预后等方面进行统计学分析,结果表明:(1)甲型H1N1流感患者发病年龄段高峰集中在中青年,多直接收治隔离治疗,发病患者年龄越大,住院时间越长。(2)临床症状及体征无明显特异性,与季节性流感相似,以发热为主要表现,可伴有咳嗽、咳痰、咽痛、呼吸困难等非特异性症状。病情进展快者,易并发肺炎、心肌炎、呼吸衰竭等并发症,甚至危及生命。(3)血常规以白细胞及淋巴细胞减低为主要表现,乳酸脱氢酶及白蛋白均有不同程度的降低,痰培养的结果阳性率较低,多为耐药菌及真菌感染。(4)胸部X线及肺CT多显示肺间质及实质的病变,重症及危重患者可在短时间内出现“白肺”表现,对于合并肺炎,病情有加重趋势的患者,主张早期应用适量激素治疗及合理给予抗生素,激素用量和用药时机需根据具体病情而决定,抗生素的应用可根据药敏定性结果确定,多应用广谱抗生素。(5)多数甲型H1N1流感患者预后较好,即使合并肺炎仍可治愈,只有个别患者病情进展较快,危及生命。更多还原

【Abstract】 Background and objectiveInitial 2009, the first epidemic outbreak of respiratory disease in Mexico, gradually spread led to global pandemic, WHO has been would alert level from the first three, raised to six in the short term, which further indicates that the formation of a global pandemic, and later confirmed, the new swine flu epidemic was derived from the influenza virus A (H1N1) - (S-OIV) are present. This disease is a respiratory infectious disease and presented with fever, cough, sputum, sore throat, breathing difficulties and other respiratory symptoms more common, but many are not typical and non-specific, therefore prone to misdiagnosis and missed, resulting in more large-scale epidemic. The current research on the influenza A (H1N1) has become the focus of attention, its significance is not only to control the pandemic, but also guidance the outbreak of pandemic in the future.Taking into account the presence of virus mutation and timeliness of disease, etc., this collection focus on the outbreak of influenza illness 3 months ago, in the first Hospital of Jilin University. And diagnosed as influenza A(H1N1)and hospital treatment of 30 patients with isolated cases of data retrospective analysis, analysis of its epidemiology and clinical features, laboratory findings, diagnosis and treatment measures ,in order to arouse the attention of clinicians to avoid misdiagnosis and to enhance the level of diagnosis and treatment of the disease, which have some guidance in preventing of influenza pandemic broke out in the future.Materials and methodsIn this article, the virus nucleic acid detection were H1N1, and hospitalization data of 30 patients were retrospectively from the First Hospital of Jilin University from October 2009 to December 2009 period, the CDC line in Changchun City. The records of 30 patients with age, sex, disease duration ,variety of clinical features and laboratory parameters, then records the results were analyzed, concludes the characteristics and symptoms occur, laboratory results and treatment experiences, to constitute the incidence, etc. Through the image changes in patients with severe changes of understanding disease.Results:(1) 30 cases of Influenza A H1N1 influenza patients, 12 male patients, 18 females, aged 13-70 years, mean age 38 years, age 20-50 years with mostly young, most of them 20-29 years of age, age the elderly, hospital stay longer.(2) Onset of the disease, past more than a certain underlying diseases, pregnant women, the incidence rate was higher for high-risk groups, the incidence in patients with more direct isolation.(3) Clinical manifestations: 30 cases exist in the pathogenesis of fever, mostly irregular heat type, the other common symptoms are cough, sputum (83.3%), chest tightness, shortness of breath, difficulty breathing is even (50%), sore throat (53.3%), bloody sputum (13.3%), etc.(4) Laboratory:①blood leukocyte counts were normal and decreased (73.3%) more than the percentage of lymphocytes decreased. Most patients with abnormal myocardial enzyme LDH increased in patients with disease higher than the apparent weight.②80% of early stage there is decreased serum albumin, and more volatile 25-30g / L.③the abnormal sputum culture in 5 cases, respectively, Stenotrophomonas maltophilia in 2 cases, 1 case of Enterococcus faecalis, in the amount of candida tropicalis in 1 case, 1 case of Mucor, the resistant and fungal infection, check the positive rate is not high.(5) Imaging for different levels of flaky, patchy infiltrative shadows, rapid progression, severe and even shows diffuse reticular, ground glass-like change. For there to change the image, and accompanied by flu-like symptoms in patients with hormone dosage of 40 ~ 160mg twice a day application of hormones, patients with more severe impact to the 500mg dose.(6) 2 cases of 30 patients died, all had underlying diseases, and another one case of multiple organ dysfunction syndrome, was discharged because of economic reasons.Conclusion:(1) The onset of influenza A(H1N1) peak concentration in young and middle age, and more directly admitted to isolation and treatment, incidence of older patients in hospital longer. (2) no obvious clinical symptoms and signs of specificity, similar to seasonal influenza, with fever as the main performance, may be associated with cough, sputum, sore throat, difficulty breathing and other non-specific symptoms. Rapid progression who may predispose to pneumonia, myocarditis, respiratory failure and other complications, even life-threatening. (3) leukocytes and lymphocytes in blood in order to reduce as the main performance, lactate dehydrogenase and albumin and have different levels of reduction, the results of sputum culture positive rates of lower,mostly resistant and fungal infections. (4) chest X ray and lung CT showed pulmonary interstitial and more substantial lesions, severe and critical patients in a short time a "white lung" performance, for the merger of pneumonia, the condition of patients with increased trend, advocates of early appropriate and reasonable to give antibiotics, hormone therapy, hormone dosage and administration time to be determined according to specific conditions, the application of antibiotic susceptibility qualitative results according to established multi-application broad-spectrum antibiotics. (5) Most patients with good prognosis Influenza H1N1 influenza, pneumonia, even if the merger is still curable, but only a rapid progression in patients with life-threatening.更多还原