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目的探讨危重症甲型H1N1流感的发病特点及诊治要点。方法对7例危重症甲型H1N1流感患者的诊疗经过动态观察,重点分析危重症甲型H1N1患者的T淋巴细胞免疫状况、双肺炎症暴发式进展及纤维化演变吸收的特点;总结氧疗、糖皮质激素应用指征、时间窗及剂量增减体会;评估免疫调控及免疫佐剂的辅助治疗价值,结合临床资料并进行文献复习。结果危重症患者均以流感起病并进展迅速,早期出现胸闷症状;T淋巴细胞及其亚群(CD3+、CD4+、CD8+T细胞)计数明显下降;经氧疗、抗感染,免疫增强、激素及营养支持等综合治疗,7例患者均好转出院,病程(22±5)d。结论危重症甲型H1N1流感诊断的关键是提高意识;细胞免疫功能测定有一定的预警价值。治疗成功的关键是保障氧合,合理的激素使用干预炎症瀑布效应;免疫增强和营养支持具有重要的辅助治疗作用。
Objective To investigate the onset and treatment of critically ill type A H1N1 influenza. Methods The diagnosis and treatment of 7 cases of critically ill patients with swine influenza A (H1N1) virus were dynamically observed, focusing on the analysis of T lymphocyte immune status, the development of pneumonitis and the evolution of fibrosis in critically ill patients with type A H1N1. The effects of oxygen therapy, Glucocorticoid indications, time window and dose increase and decrease of experience; assessment of adjuvant immune regulation and adjuvant adjuvant therapy value, combined with clinical data and literature review. Results The critically ill patients all started with the flu and progressed rapidly. Early symptoms of chest distress. The count of T lymphocytes and its subgroups (CD3 +, CD4 +, CD8 + T cells) decreased significantly. After treatment with oxygen therapy, anti-infection, And nutritional support and other comprehensive treatment, 7 patients were better discharged, the duration of (22 ± 5) d. Conclusions The key to diagnosis of severe type A H1N1 influenza is to raise awareness; the determination of cellular immune function has certain value in early warning. The key to successful treatment is to protect the oxygenation, reasonable use of hormones to interfere with inflammatory waterfall effect; immune enhancement and nutritional support has important adjuvant therapy.