Louriz Maha, Mahraoui Chafiq, Azzouzi Abderrahim, El Fassy Fihri Mohamed Taoufiq, Zeggwagh Amine Ali, Abidi Khalid, Ferhati Driss, Echcherif El Kettani Salma, Tachinante Rajae, Belayachi Jihane, Zekraoui Aicha, Sefiani Yasser, Charif Chefchaouni Al Mountacer, Abouqal Redouane
Ibn Sina University Hospital, 10000, Rabat, Morocco.
Int Arch Med. 2010 Oct 27;3:26. doi: 10.1186/1755-7682-3-26.
The first case of 2009 pandemic influenza A (H1N1) virus infection in our center was documented on June 15. Subsequently, persons with suspected cases of infection and contacts of those with suspected infection were tested. Persons in whom infection was confirmed were hospitalized and quarantined, and some of them were closely observed for the purpose of investigating the nature and duration of the disease. The aim of the present study was to describe baseline characteristics, treatment, outcomes, hospital length of stay and mortality of the first 186 cases of influenza A (H1N1) virus infection, with special interest in those developing severe respiratory failure with intensive care unit (ICU) care requirement.
observational study of 186 consecutive cases of influenza A (H1N1) virus infection admitted in 3 departments that were reference centers for the care of patients with influenza A and 4 ICU in Ibn Sina university hospital (Rabat, Morocco) between June and December 2009. Real time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) testing was used to confirm infection. Demographic data, symptoms, comorbid conditions, illness progression, laboratory and chest radiologic findings, treatments, clinical outcomes and ICU care requirement were closely monitored.
The mean age of the 186 patients was 17.6 ± 14.8 years, 47.8% had less than 14 years and 57% were male. The median duration of symptoms before hospital admission was 3 days (interquartile range (IQR): 2-5). The most common symptoms were fever (in 91.5% of the patients), cough in 92.5%, and nasal congestion in 62.4%. Twenty four percent of patients had comorbid respiratory disorders and 7.5% were pregnant. Abnormalities in chest radiography were detected in 26.3% of 186 patients on admission or after hospitalization. Twenty patients have required ICU care and 10 have required mechanical ventilation. The hospital length of stay was 5 days (IQR: 4-5). The following were risk factors of ICU admission: older age (p = 0.03), long duration of symptoms (p = 0.07), asthma (p = 0.01), obesity (P < 0.001), abnormalities of chest radiography (P < 0.001), leukocytosis (p = 0.005), and higher C-reactive protein (CRP) (P < 0.001). The ICU length of stay was 4 days (IQR: 3-6.7). The mortality rate was 3.5% among all patients and 30% among ICU patients.
Close observation of patients infected with the 2009 pandemic influenza A (H1N1) virus infection provided us with several information. The influenza A (H1N1) virus infection affected young people particularly, with comorbid respiratory disorders. Risk factors of ICU admission were older age, long duration of symptoms, asthma, obesity, abnormalities of chest radiography, leukocytosis and higher CRP. Clinicians should be aware of complications of influenza A (H1N1) virus infection, particulary in patients with risk factors.
2009年6月15日，我院确诊首例甲型H1N1流感病毒感染病例。随后，对疑似感染病例及其接触者进行了检测。确诊感染的患者被收治入院并隔离，部分患者接受密切观察，以研究疾病的性质和病程。本研究旨在描述首例186例甲型H1N1流感病毒感染病例的基线特征、治疗情况、转归、住院时间和死亡率，尤其关注那些发展为需要重症监护病房（ICU）治疗的严重呼吸衰竭患者。
对2009年6月至12月期间在伊本·西那大学医院（摩洛哥拉巴特）3个甲型流感患者护理参考科室和4个ICU连续收治的186例甲型H1N1流感病毒感染病例进行观察性研究。采用实时逆转录聚合酶链反应（RT-PCR）检测确诊感染。密切监测人口统计学数据、症状、合并症、疾病进展、实验室及胸部影像学检查结果、治疗情况、临床转归及ICU治疗需求。
186例患者的平均年龄为17.6±14.8岁，47.8%的患者年龄小于14岁，57%为男性。入院前症状持续时间的中位数为3天（四分位间距（IQR）：2-5）。最常见的症状为发热（91.5%的患者）、咳嗽（92.5%）和鼻塞（62.4%）。24%的患者合并呼吸系统疾病，7.5%为孕妇。186例患者中，26.3%在入院时或住院后胸部X线检查异常。20例患者需要ICU治疗，10例需要机械通气。住院时间为5天（IQR：4-5）。以下因素为入住ICU的危险因素：年龄较大（p = 0.03）、症状持续时间长（p = 0.07）、哮喘（p = 0.01）、肥胖（P < 0.001）、胸部X线检查异常（P < 0.001）、白细胞增多（p = 0.005）及C反应蛋白（CRP）升高（P < 0.001）。ICU住院时间为4天（IQR：3-6.7）。所有患者的死亡率为3.5%，ICU患者的死亡率为30%。
对2009年甲型H1N1流感病毒感染患者的密切观察为我们提供了一些信息。甲型H1N1流感病毒感染尤其影响年轻人，且常合并呼吸系统疾病。入住ICU的危险因素包括年龄较大、症状持续时间长、哮喘、肥胖、胸部X线检查异常、白细胞增多及CRP升高。临床医生应意识到甲型H1N1流感病毒感染的并发症，尤其是有危险因素的患者。
