Department of Anaesthesia and Critical Care City Hospital, Sandwell and West Birmingham NHS Trust, Dudley Road, Birmingham B18 7QH, UK.
Br J Anaesth. 2010 Feb;104(2):128-42. doi: 10.1093/bja/aep375. Epub 2010 Jan 5.
The clinical picture in severe cases of pandemic (H1N1) 2009 influenza is markedly different from the disease pattern seen during epidemics of seasonal influenza, in that many of those affected were previously healthy young people. Current predictions estimate that, during a pandemic wave, 12-30% of the population will develop clinical influenza (compared with 5-15% for seasonal influenza) with 4% of those patients requiring hospital admissions and one in five requiring critical care. This review covers the background, clinical presentation, diagnosis, and treatment. The role of immunization and antiviral drugs is discussed. Experience from the first wave of pandemic (H1N1) 2009 influenza suggests that a number of infected patients become critically ill and require intensive care admission. These patients rapidly develop severe progressive respiratory failure which is often associated with failure of other organs, or marked worsening of underlying airways disease. The critical care management of these patients and the implications for resources is reviewed. Guidance from a range of bodies has been produced in a relatively short period of time in response to pandemic (H1N1) 2009 influenza. Disease severity has the potential to change, especially if there is virus mutation. Clinicians must be prepared for the unexpected and continue to share their experiences to maximize patient outcomes.
严重的 2009 年甲型 H1N1 流感大流行的临床特征与季节性流感流行期间的疾病模式明显不同，因为许多受影响者是以前健康的年轻人。目前的预测估计，在大流行浪潮期间，12-30%的人口将出现临床流感（季节性流感为 5-15%），其中 4%的患者需要住院治疗，五分之一需要重症监护。这篇综述涵盖了背景、临床表现、诊断和治疗。还讨论了免疫接种和抗病毒药物的作用。来自 2009 年甲型 H1N1 流感第一波的经验表明，许多感染患者病情迅速恶化，需要入住重症监护病房。这些患者迅速出现严重的进行性呼吸衰竭，通常伴有其他器官衰竭，或基础气道疾病明显恶化。对这些患者的重症监护管理以及对资源的影响进行了回顾。针对 2009 年甲型 H1N1 流感，在相对较短的时间内已经制定了来自多个机构的指南。疾病的严重程度可能会发生变化，特别是如果发生病毒突变。临床医生必须为意外情况做好准备，并继续分享经验，以最大限度地提高患者的治疗效果。
