Kloth N, Weisbrodt L, McLean A, Nalos M
Department of Intensive Care Medicine, University of Sydney, Nepean Hospital, Austrálie.
Vnitr Lek. 2009 Dec;55(12):1141-4.
In late May 2009, an outbreak of the novel swine - influenza A virus (H1N1) was identified in the Southern hemisphere. We describe the clinical and epidemiologic characteristics ofpatients infected with H1N1 requiring intensive care (ICU) admission at a Sydney University Hospital.
We retrospectively reviewed medical charts and laboratory results ofall patients who tested positively for H1N1 by viral polymerase chain reaction (PCR) on nasopharyngeal smear or endobronchial secretions.
From June 1st until August 31st, 2009 a total of 17 patients required admission to the Intensive Care Unit at Nepean Hospital, a tertiary teaching hospital. There were 9 males and 8 females with a mean age of 42 years. The majority of patients were admitted to the ICU within 48 hours of hospital presentation. All patients had flu like symptoms and most presented with respiratory distress and tachycardia. More than half of patients had patchy alveolar infiltrates on chest X ray. Patients who developed acute lung injury and acute respiratory distress syndrome (ALI/ARDS) typically presented with normal leukocyte count, lymphopenia, raised C-reactive protein, creatinkinase, transaminases but normal urea and creatinine. Fourteen patients required intubation while two received non-invasive ventilation. Several patients tested negative for H1N1 on nasopharyngeal smear PCR but tested positive on endobronchial secretions and the rapid flu antigen test proved unreliable. Two patients died during hospital admission but neither from respiratory failure or its consequences. The median duration of intensive care stay was 12 days while hospital stay was 18 days.
The Nepean Hospital's patient profile and outcomes are similar to the data for all H1N1 associated ICU admission in Australia and New Zealand. H1N1 is capable of causing severe respiratory infection especially in the young to middle aged and the impact on intensive care units is disproportionate to seasonal flu. To reliably test for H1N1 in intubated patients we recommend performing viral PCR on endobronchial secretions.
2009年5月下旬，在南半球发现了新型甲型H1N1流感病毒疫情。我们描述了悉尼一家大学医院中因感染H1N1而需要入住重症监护病房（ICU）的患者的临床和流行病学特征。
我们回顾性分析了所有经鼻咽涂片或支气管分泌物的病毒聚合酶链反应（PCR）检测H1N1呈阳性的患者的病历和实验室检查结果。
2009年6月1日至8月31日期间，共有17名患者入住Nepean医院（一家三级教学医院）的重症监护病房。其中男性9名，女性8名，平均年龄42岁。大多数患者在入院后48小时内被收入ICU。所有患者均有流感样症状，多数表现为呼吸窘迫和心动过速。超过一半的患者胸部X光显示有斑片状肺泡浸润。发生急性肺损伤和急性呼吸窘迫综合征（ALI/ARDS）的患者通常白细胞计数正常、淋巴细胞减少、C反应蛋白、肌酸激酶、转氨酶升高，但尿素和肌酐正常。14名患者需要插管，2名患者接受无创通气。几名患者鼻咽涂片PCR检测H1N1呈阴性，但支气管分泌物检测呈阳性，快速流感抗原检测结果不可靠。两名患者在住院期间死亡，但均非死于呼吸衰竭及其并发症。重症监护病房的中位住院时间为12天，住院总时间为18天。
Nepean医院的患者情况和治疗结果与澳大利亚和新西兰所有与H1N1相关的ICU入院数据相似。H1N1能够引起严重的呼吸道感染，尤其是在中青年人群中，其对重症监护病房的影响与季节性流感不相称。为了可靠地检测插管患者的H1N1，我们建议对支气管分泌物进行病毒PCR检测。
