Critical Influenza A H1N1: A Report Of 7 Cases And Literature Review

Objective: To analyze the clinical characteristics,diagnosis and treatment of critical influenza A H1N1 patients in the First Affiliated Hospital of Guangxi Medical University.And it was beneficial to clinicians to improve their understanding,diagnosis and treatment of critical influenza A H1N1.Methods: The clinical data of 7 adult patients,who were diagnosed critical influenza A H1N1 in the First Affiliated Hospital of Guangxi Medical University from January 1,2016 to April 1,2019,were collected.The general situation,clinical features and its treament were analyzed retrospectively by using relevant statistical methods.Results:(1)General informations: A total of 7 cases were collected,including 5 males,2 females,1 pregnant and 1 elderly.Among the 7 cases,2 had a history of exposure to live poultry,0 had influenza vaccination,and 6 had risk factors.(2)Clinical symptoms and signs: fever,cough and fatigue were found in7 patients,shortness of breath or dyspnea in 7 patients,and muscle soreness in 2patients.Rales could be heard in 7 cases.(3)Laboratory tests were showed that peripheral white blood cell counts were decreased in 2 cases,normal in 1 cases and increased in 4 cases.The percentage of neutrophils,PCT and CRP were increased in 7 cases,while the absolute value of lymphocyte was decreased in 7cases,and myoglobin increased in 2 cases.(4)Imaging: Ground glass shadow combined with patchy solid shadow could be seen in 6 cases.Massive consolidation was found in 1 case.(5)Different complications were observed that 7 with bacterial pneumonia,7 with MODS,5 with septic shock,5 with ARDS,and 2 with rhabdomyolysis were found.(6)Treatment: Of the 7 patients,7 cases were treated with oseltamivir antiviral and mechanical ventilation,5cases with glucocorticoid and 2 cases with ECMO.(7)Outcome: Among the 7patients,2 improved,1 gave up treatment,3 died and 1 was transferred to other hospital.Conclusion: 1.Patients with critical influenza A H1N1 have multiple underlying diseases or high-risk factors,which are prone to multiple complications.In the diagnosis and treatment,the patients have serious illness,rapid progress,poor prognosis and high mortality.2.The clinical manifestations of critical influenza A H1N1 are mainly fever,progressive dyspnea and cough.Imaging is mainly characterized by ground glass,consolidation and post-fibrosis.3.It is very important to rescue critically ill patients by invasive mechanical ventilation and ECMO treatment.However its prognosis may also be related to the application timing and other factors.4.If the antiviral treatment with oseltamivir is later than 48 hours after the onset of H1N1,it is more likely to develop critical influenza A H1N1 and have a poorer prognosis.5.High-dose oseltamivir is more effective than low-dose oseltamivir in treating patients with critical influenza A H1N1.6.It is no benefit basis to use glucocorticoid for the prognosis of patients with critical influenza A H1N1.