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目的:研究早期及时抗病毒治疗妊娠合并重症甲型H1N1流感患者对母儿围产预后的影响。方法:回顾性分析2009年11月7日～2010年1月30日于中国医科大学附属盛京医院就诊的妊娠合并重症甲型H1N1流感患者18例,比较48h内用药(早期用药组,n=6)与48h后用药(晚期用药组,n=12)患者的妊娠结局及预后相关指标,包括住院时间、进行机械通气时间、术前氧合指数、肌酸激酶(CK)、乳酸脱氢酶(LDH)水平和新生儿预后情况。结果:早期用药组均痊愈,晚期用药组2例死亡。与早期用药组相比,晚期用药组平均住院时间长(P=0.009),进行机械通气时间多(P=0.028),CK水平高(P=0.018);而两组间术前氧合指数、LDH水平则无统计学差异(P>0.05)。早期用药组新生儿出生后均无窒息症状,晚期用药组胎死宫内3例,1例死亡和1例轻度窒息,7例Apgar评分10分。所有存活新生儿生后3天进行咽拭子检查均为阴性,且无流感表现,6例继续妊娠至足月后分娩的新生儿均未发现畸形。随访2～9个月,婴儿体格发育和智力发育同正常同龄儿。结论:发病48h内及时应用药物治疗的重症患者预后明显优于发病48h后应用药物治疗的患者,且前者新生儿的预后亦明显优于后者。采用奥司他韦抗病毒治疗妊娠中期和晚期的甲型H1N1流感患者对母儿均是安全的,未见致畸作用。若疑似为妊娠合并甲型H1N1的患者应及时尽早给予抗病毒治疗,可以获得较好的母儿预后。
Objective: To study the effect of early and timely antiviral therapy on the prognosis of perinatal infants in pregnant women with severe type A (H1N1) infection during pregnancy. Methods: A retrospective analysis of 18 patients with severe H1N1 influenza during pregnancy in Shengjing Hospital affiliated to China Medical University from November 7, 2009 to January 30, 2010 was retrospectively analyzed. Drugs administered within 48 hours (n = 6) The pregnancy outcomes and prognosis-related indicators including hospital stay, duration of mechanical ventilation, preoperative oxygenation index, creatine kinase (CK), lactate dehydrogenase (LDH) levels and prognosis of newborns. Results: Early treatment group were cured, two patients died in the late group. Compared with those in the early treatment group, the average length of hospital stay (P = 0.009), mechanical ventilation time (P = 0.028), and CK level (P = 0.018) There was no significant difference in LDH level (P> 0.05). Neonatal infants in the early treatment group had no asphyxia after birth, in the late treatment group, 3 were intrauterine fetal death, 1 died and 1 mild asphyxia, and Apgar score was 10 in 7 patients. Throat swabs were negative for all surviving newborns 3 days after birth, and showed no flu symptoms. No abnormalities were found in 6 infants born after term pregnancy. Follow-up 2 to 9 months, physical development and mental development of infants with normal children of the same age. Conclusion: The prognosis of critically ill patients receiving timely drug treatment within 48 hours after onset is significantly better than that of patients receiving medical therapy after 48 hours of onset. The prognosis of newborns in the former group is also significantly better than the latter. The use of oseltamivir antiviral therapy in the second trimester of pregnancy in patients with influenza A H1N1 influenza are safe for both mother and child, no teratogenic effects. If suspected pregnancy complicated with H1N1 patients should be promptly given antiviral therapy, you can get a better prognosis of maternal and child.