Intensive Care Unit, Hospital Virgen del Camino, Pamplona, Spain.
Crit Care Med. 2011 May;39(5):945-51. doi: 10.1097/CCM.0b013e318208ee12.
To describe the severity of the 2009 influenza A/H1N1v illness among pregnant women admitted to Spanish intensive care units.
Prospective, observational, multicenter study conducted in 148 Spanish intensive care units. We reviewed demographic and clinical data from the Spanish Society of Intensive Care Medicine database reported from April 23, 2009, to February 15, 2010. We included women of reproductive age (15-44 yrs) with confirmed A/H1N1v infection admitted to intensive care units.
Two hundred thirty-four women of reproductive age were admitted to intensive care units, 50 (21.4%) of them pregnant. Seven deaths were recorded in pregnant and 22 in nonpregnant women. Among intensive care unit admissions, there were no statistically significant differences between pregnant women and nonpregnant in Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment scores, chest x-rays, inotrope requirement, or need for mechanical ventilation or steroid therapy. Mortality risk was significantly associated with Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment, and obesity. Viral pneumonia was more frequent in pregnant women than in nonpregnant women, with an odds ratio (adjusted for asthma, time from onset influenza symptoms to hospital admission and obesity) of 4.9 (95% confidence interval: 1.4-17.2). The development of primary viral pneumonia in women of reproductive age appeared to be related to the time of commencement of antiviral treatment, the lowest rates being reported with initiation of antiviral therapy within 48 hrs of symptom onset (63.6% vs. 82.6%, p = .03). However, antiviral therapy was started within this time span in only 14% of pregnant women.
More than 20% of women of reproductive age admitted to intensive care unit for pH1N1 infection were pregnant. Pregnancy was significantly associated with primary viral pneumonia. Pregnant women should receive prompt treatment with oseltamivir within 48 hrs of the onset of influenza symptoms.
描述西班牙重症监护病房收治的甲型 H1N1v 流感孕妇的病情严重程度。
这是一项在西班牙 148 家重症监护病房进行的前瞻性、观察性、多中心研究。我们回顾了 2009 年 4 月 23 日至 2010 年 2 月 15 日期间从西班牙重症监护医学学会数据库报告的人口统计学和临床数据。我们纳入了年龄在 15-44 岁之间、确诊为甲型 H1N1v 感染并入住重症监护病房的女性。
共有 234 名育龄妇女入住重症监护病房，其中 50 名（21.4%）为孕妇。7 例死亡发生在孕妇中，22 例发生在非孕妇中。在重症监护病房收治的患者中，孕妇和非孕妇之间在急性生理学和慢性健康评估 II、序贯器官衰竭评估评分、胸部 X 线、儿茶酚胺需求或需要机械通气或类固醇治疗方面无统计学显著差异。死亡风险与急性生理学和慢性健康评估 II、序贯器官衰竭评估以及肥胖显著相关。与非孕妇相比，孕妇更易发生病毒性肺炎，调整哮喘、流感症状出现至入院时间和肥胖因素后，其优势比（95%置信区间：1.4-17.2）为 4.9。育龄妇女原发性病毒性肺炎的发生似乎与抗病毒治疗的开始时间有关，症状出现后 48 小时内开始抗病毒治疗的最低发生率为 63.6%（与 82.6%相比，p=0.03）。然而，只有 14%的孕妇在这段时间内开始接受抗病毒治疗。
超过 20%的因 pH1N1 感染入住重症监护病房的育龄妇女怀孕。妊娠与原发性病毒性肺炎显著相关。孕妇应在流感症状出现后 48 小时内及时接受奥司他韦治疗。
