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1、32栽蚤葬灶躁蚤灶醞藻鑿允熏Jan圓園10熏災(zāi)燥造38暈燥1甲型H1N1流感專題重癥甲型H1N1流感病毒肺炎的臨床和病理特征*吟李冠華張力李月川賈瑋張冬睿高淑連趙勇摘要目的：探討危重癥甲型H1N1流感病毒（甲流）肺炎患者的主要臨床特點，分析其氣道內(nèi)分泌物及肺、心臟病理學(xué)改變與持續(xù)性低氧血癥的關(guān)系。方法：回顧性分析入住呼吸重癥監(jiān)護病房（RICU）的24例危、重癥甲流肺炎患者的臨床資料。24例均用抗病毒治療（達菲劑量75或150mg）每日2次，24例中20例用激素治療，6例行氣管插管機械通氣治療。結(jié)果：24例患者平均年齡（48.25依19.73）歲，孕產(chǎn)婦
2、、肥胖及有慢性基礎(chǔ)病者15例。進行性氣短、咳嗽、肌肉酸痛是主要癥狀。雙肺多發(fā)實變影22例（91.67%）。入院后5例氣道內(nèi)分泌物中蛋白質(zhì)為34.1~37.7g/L，乳酸脫氫酶（蘊DH）為792~1890U/L。白細(xì)胞計數(shù)為（0.722~1.470）伊109/L，中性粒細(xì)胞0.21~0援源源，單核細(xì)胞為0.111~0.560，嗜酸粒細(xì)胞為0.027~0.110，嗜堿粒細(xì)胞為0.018~0.054。病理學(xué)變化有肺透明膜形成、肺泡腔塌陷、心肌細(xì)胞變性和心肌灶性壞死。氣管插管機械通氣支持治療6例，死亡5例，病死率20.83%。結(jié)論：氣道內(nèi)分泌物L(fēng)DH、蛋白質(zhì)升
3、高、炎性細(xì)胞增多是危重癥甲流肺炎患者肺部病理損害的表現(xiàn)；機械通氣支持治療對于肺內(nèi)廣泛實變者效果不理想，且相關(guān)的并發(fā)癥是部分患者病情加重或死亡的促發(fā)因素。關(guān)鍵詞流感病毒A型,H1N1亞型流感,人肺炎,病毒性危重病重癥監(jiān)護病房呼吸,人工奧司他韋病理學(xué),臨床肺心臟ClinicalandPathologicalFeaturesofSevereInfluenzaAH1N1InfluenzaVirusPneumoniaLIGuanhua,ZHANGLi,LIYuechuan,JIAWei,ZHANGDongrui,GAOShulian,ZHAOYongTianji
4、nMedicalUniversity,Tianjin300070,ChinaAbstractObjective：ToinvestigatethemainclinicalfeaturesofcriticallyillpatientswithinfluenzaA(H1N1)influenzaviruspneumonia,andtherelationshipbetweenairwaysecretionsandcardiopulmonarypathologychangewithcontinuoushy鄄poxemia.Methods:Theretrospect
5、iveanalysiswasmadeincriticallyillpatientswithH1N1influenzaviruspneumoniaadmit鄄tedtoarespiratoryintensivecareunit(RICU).Twenty-fourpatientswerealladministratedantiviraldrugs(oseltamivir75/150mgBid).Twentyofthemweresubjectedtoapplicationofhormonaltherapy,and6ofthemwithmechanicalve
6、ntilation.Results:Theaverageageof24patientswas(48.25依19.73)yearsold.Fifteenofthemwerepregnantwomen,obesityandwhosufferedfromchronicunderlyingdiseases.Themainsymptomsofthemwereprogressiveshortnessofbreath,coughandmyal鄄gia.ItwasfoundbyX-raythat22patients(91.67%)hadmultiplelungcons
7、olidationshadow.Afteradmission,airwaysecre鄄tionswerecollected,andtheproteinconcentrationofwhichwas34.1-37.7g/Lin5cases.Theconcentrationofl-lactatedehy鄄drogenase(LDH)was792-1890U/L.Whitebloodcellcountwas(0.722-1.470)伊109/L袁included0.21-0.44neutrophils,0.111-0.560mononuclearcells,
8、0.027-0.110eosinophils,0.018-0.054basophils.Pat
