Division of Pulmonology, Department of Medicine, University of Stellenbosch, PO Box 19063, Tygerberg, 7505, Cape Town, South Africa.
QJM. 2010 May;103(5):319-25. doi: 10.1093/qjmed/hcq022. Epub 2010 Mar 10.
The novel influenza A (H1N1) pandemic affected South Africa late during the 2009 Southern hemisphere winter and placed an extra burden on a health care system already dealing with a high prevalence of chronic lung diseases and human immunodeficiency virus (HIV) infection.
The aim of this study was to describe the epidemiological characteristics, clinical features, management and outcomes of patients with confirmed influenza A (H1N1) infection complicated by respiratory failure.
We included all adult patients with confirmed influenza A (H1N1) infection that were referred to the medical intensive care unit of a large academic hospital in Cape Town for ventilatory support in this prospective observational study.
A total of 19 patients (39.5 +/- 14.8 years) needed ventilatory support over a 6-week period. Of these, 15 were female and 16 had identifiable risk factors for severe disease, including pregnancy (n = 6), type 2 diabetes mellitus (n = 6), obesity (n = 4), HIV infection (n = 3), immunosuppressive therapy (n = 3) and active pulmonary tuberculosis (n = 2). The most frequent complications were acute renal failure (n = 13), acute respiratory distress syndrome (n = 12) and ventilator associated pneumonia (n = 10). Thirteen patients died (mortality: 68.4%). Fatal cases were significantly associated with an APACHE II score >or=20 (P = 0.034), but not with a P(a)O(2)/F(I)O(2) <200 (P = 0.085) and a chest radiograph score >or=12 (P = 0.134).
The majority of patients with respiratory failure secondary to influenza A (H1N1) infection were young females and had an underlying risk factor for severe disease. The condition had a high mortality, particularly amongst patients with an APACHE II score >or=20.
新型甲型 H1N1 流感于 2009 年南半球冬季晚期侵袭南非，给本已深受慢性肺部疾病和人类免疫缺陷病毒（HIV）感染流行之苦的卫生保健系统带来额外负担。
本研究旨在描述确诊患有甲型 H1N1 流感并伴有呼吸衰竭的患者的流行病学特征、临床特征、治疗方法和结局。
我们进行了一项前瞻性观察性研究，纳入所有因呼吸衰竭而转至开普敦一所大型学术医院内科重症监护病房进行通气支持的确诊甲型 H1N1 流感成年患者。
在 6 周时间内，共有 19 名患者（39.5 ± 14.8 岁）需要通气支持。其中，15 名为女性，16 名患者存在严重疾病的明确危险因素，包括妊娠（n = 6）、2 型糖尿病（n = 6）、肥胖（n = 4）、HIV 感染（n = 3）、免疫抑制治疗（n = 3）和活动性肺结核（n = 2）。最常见的并发症是急性肾衰竭（n = 13）、急性呼吸窘迫综合征（n = 12）和呼吸机相关性肺炎（n = 10）。13 名患者死亡（病死率：68.4%）。死亡病例与急性生理学与慢性健康状况评分系统 II 评分＞20 显著相关（P = 0.034），但与动脉血氧分压/吸入氧浓度比值＜200 （P = 0.085）和 X 线胸片评分＞12 （P = 0.134）无关。
继发于甲型 H1N1 流感的呼吸衰竭患者多数为年轻女性，且存在严重疾病的潜在危险因素。该疾病死亡率较高，尤其是急性生理学与慢性健康状况评分系统 II 评分＞20 的患者。
