Review Analysis Of 119 Severe Cases Of A/H1N1 Influenza

BACKGROUND: In April 2009, an outbreak of a respiratory illness later proved to be caused by novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in Mexico,then rapidly spread to the whole word and has caused many people to be hospitalized,even to die. This clinical review of the 119 severe ceses of A/H1N1 influenza in Changchun City described the virology, epidemiology, clinical manifestations, diagnosis and treatment of the A/ H1N1 influenza .OBJECTIVE:To investigate the clinical character and the course of diagnosis and treatment , summarized the experience of the A/ H1N1 influenza.METHODS: We retrospectively analyze the laboratory-confirmed cases of pandemic H1N1 influenza reported in the city of Changchun, Jilin province, with dates of symptom onset between November and December , 2009.RESULTS: 1, General information:A total of 119 cases of A/H1N1 influenza contion 13 cases death and 106 cases recovered from the illness. 68 case patients were between 18 and 65 years of age(57.% percent of the total), the fatality rate(14.7%) is higher than other persons(5.6%).Obesity and pregnant women also have a higher fatality rate than other peesons. The fatality rate of the rural patients(67/119)is 9/58(15.5%),while the urban patients(52/119)is 4/48(8.3%). The fatality rate of rural pregnant women is 7/17(41.2%),while 5 cases of the urban pregnant women totally recovered. 2, Clinical manifestations:Almost all the patients had fever(98.3%), cough(85.7%), headache and muscle pain(80.6%) etal.influenza symptom, and have 5 diarrhea cases.severe patients rapidly occur dyspnea ,have pink spumous sputum and respiratory failure. There are 48 cases have type I respiratory failure,then 28 ceses turn to type II respiratory failure. 3, Supplementary examination: (1), A routine blood test: the 119 cases have an initial test ,there are 82 patients of the 106 cured patients have White Blood Count normal or lower,compare to 7 cases of the 13 cases of death (not include 1 patient who suffer from M5). 7 days after admission 12 patients were increased WBC count, maximum count of 15.0-46.4×109 / l. There are 7 cases have Platelet count decreased, 6 / 7 cases of pregnant women with moderate to severe anemia. (2), Blood biochemical: almost all the 13 deaths patients with abnormal of ALB, LDH, AST, BUN, ALT. 54 of 106 (50.9%) cured cases occurred ALB and CHE) lower, 76 (76/106 = 71.7%) patients had LDH, AST, ALT, CK-MB increase, in which 47 (47/106 = 44.3%)cases appear LDH elevated. (3), Etiology: The throat swab of the total 119 cases been detected, using RT-PCR by Epidemic Prevention Station of Changchun, all of the patients have positive result of A/H1N1 influenza virus nucleic acid. majority of the sputum culture is G-bacteria and Candida. (4), Imaging: A total of 31 cases (13 deaths, 18 were cured) patients showed multiple lung lobe and segment appear patchy film, most of which have air bronchogram. 4,Treatment:(1), Antiretroviral therapy: 119 patients were all taking the oseltamivir treatment. 1 of 13 dead cases was taken oseltamivir within 4 days, while 72 patients of 106 who were cured were taken. The statistical analysis of mortality rate is significantly different. (2), Mechanical ventilation treatment: all of the 13 dead patients used invasive mechanical ventilation, with mode of SIMV.The peep value of children is 9cmH2O-14cmH2O.Peep value of 11 adult cases is 11cmH2O-35cmH2O. Inhaled oxygen concentration was between 70% -100%. The improving of oxygen saturation after using mechanical ventilation is not obvious, culminating occur type II respiratory failure and eight cases of barotrauma. 35 of 106 cured cases have type I respiratory failure, 20 cases use invasive mechanical ventilation and 15 were non-invasive ventilation. the peep value of the Invasive ventilation is 10-30cmH2O and 5 cases of barotrauma. (3), Antibiotic treatment: Most of the 13 patients who died in hospital early application of theβ-lactam / inhibitor compound, a joint use of two to three kinds of carbapenems, vancomycin, the fourth generation quinolone and other broad spectrum antibiotics, most of the 13 death cases are complicated by a resistant infection. 78 of the 106 cured cases simplely use one kind of the two generations cephalosporin ,β-lactam / inhibitor compound, and three generations of quinolone azithromycin etal.antibiotics. (4), The use of Glucocorticoid: 58 cases of the 119 patients used glucocorticoid therapy, 7 cases of the 13 deaths used high-dose pulse therapy, the remaining 4 cases of adult patients with a less than 80mg, 2 times / day of glucocorticoid dosage. 45 patients of 106 Cured cases used corticosteroids, 10 patients with high-dose pulse therapy. (5), Other treatment methods: 13 died patients used A/H1N1 influenza patients's recovery period plasma and normal plasma, 11cases of 106 cured patients have used. 13 dead patients used Xuebijing + ulinastatin treatment, 5 cases use Xuebijing treatment. 7 patients of 13 dead cases used CRRT ,while 2 cases of the 106 patients used CRRT.CONCLUSION: The influenza A/H1N1 in 2009, 18 to 65 age group have a higher proportion of severe patients and mortality was significantly higher than other age groups of patients. The mortality of pregnant women and obesity is higher than the general population. Pregnant women in rural areas, rural severe patients have a higher proportion of severe patients than the city. In addition to fever, cough, flu-like symptoms etal.clinical manifestations, there is diarrhea. Rapidly occur dyspnea, cough pink bubble sputum, psychiatric symptoms in patients with poor prognosis. The severe patients appear type I respiratory failure in early stage, despite used the high peep, the high concentration of oxygen, oxygenation improvement unconspicuous,mechanical ventilation ineffective, instead increased the incidence of complications, such as barotrauma, ventilator-associated pneumonia, then change to type II respiratory failure, and have poor prognosis. Blood count showed white blood cell count normal or fall in early stage, with bacterial or fungal infection increased, if the white blood cells continued significantly higher than normal, it have poor prognosis. Blood biochemical test ,in addition to ALB, CHE reduction, LDH elevation point out poor prognosis, AST, CK-MB elevation are also important relationship with the prognosis of patients. The patients'Prognosis and lung imaging heve a positive correlation.The larger the area of lung involvement ,the worse of the prognosis, and the higher of the mortality.The culture result of blood, sputum, urine and shit of severe hospitalize Patients mainly appears G-bacteria and Candida, there HAP is one of the cause of death in patients with severe A/N1N1 . Early taking the neuraminidase inhibitors is one of the key treatment, and svere patients and high risk attacked of influenza A/H1N1 must use as soon as possible, if taken after 4 days, the mortality will be significantly increased. Influenza A/H1N1 patients should be mainly used antiviral therapy in early stage,we do not promote the use of broad-spectrum antibiotics. The more broad antimicrobial spectrum used in early stage, the greater likelihood of nosocomial infection, Lan-negative bacilli resistant and fungal infection, result to more difficult treatment.The use of corticosteroids in patients with severe influenza H1N1 is effective, but do not suggest long-term, heavy use, so as not to cause immune suppression and increased infections and prolong the duration of viral replication.Antioxidant and anti-free radical substances, A/H1N1 patients convalescent plasma, continuous renal replacement therapy as a supportive therapy, critically ill patients can consider to use.