Retrospective Case Study On2009a (H1N1)Influenzal Patients In Hospital In Tianjin

[Objective] Discuss the potential risk factors of the Influenza A (H1N1) patients from severe case develop into a critical illness or even death, and to discuss the possible effects and related adverse reactions of glucocorticoids in the treatment process.[Methods] Retrospectively analysis114confirmed cases (in accordance with the People’s Republic of China (H1N1) influenza treatment program (2009third edition) diagnostic criteria) of severe and critical ill patients that were influenza A (H1N1) of Tianjin area (11hospitals including Tianjin Haihe Hospital) from September2009to December2009. According to the severity level of the disease,the patients are divided into the severe group(n=70)and critical group(n=44),and according to the prognosis of patients into the survival group (n=99) and death group (n=15), repetitively analyze and compare patients gender,age, treatment time, number of visits due to this disease, the presence of underlying diseases and the incidence before the onset of the underlying disease with or without increase, whether the pregnancy,treatment of sym-ptomms,signs,laboratory and imaging studies data before hospitalized and the incide-nce of complications of the disease,to discuss the risk factors of the influenza A (H1N1) are more likely to develop into the severe critical illness or even death; And separately compare patients’leukocyte count、neutrophil ratio、CK、AST、LDH、TBIL、 oxygenation index、body temperature、respiratory rate、systolic blood pressure diastolic blood pressure、blood sugar changes before the application of glucocorticoid treatme nt,after treatment for one day,for three days,for seven days to discuss the possible effects of glucocorticoids in the treatment process and related adverse reactions.[Results] The results show that through retrospective analysis of114cases of confirmed cases of the influenza A (H1N1) severe and critical illness located in Tian jin2009:1. The difference comparison between the critically sever group patients and critical group patients upon with or without underlying diseases increase before admi-ssion、the improvement rate、mortality rate、respiratory rate、heart rate、hemoptysis、 dyspnea、symptoms of nervous system、disturbance of consciousness、cyanosis、 pulmonary raies、leukocyte count、lymphocyte ratio, AST、LDH、Na、PT、APTT、X-ray extent of disease than lung field1/2and the pleural fluid was statistically significant (P<0.05), and the rate difference comparison between pneumothorax or mediastinal emphysema ARDS, acute renal failure and liver damage complication was statistically significant.2. The difference comparison between deaths group patients and survival group patients upon respiratory rate heart rate, hemoptysis, dyspnea, unconsciousness、 cyanosis, neutrophil ratio、platelet count、X-ray extent of disease than lung field1/2is statistically significant(P<0.05),and the rate difference comparison between pneumo-thorax or mediastinal emphysema、ARDS、acute renal failure、liver damage、DIC and secondary infection complication was statistically significant.3.the temperature com-parison among the severe group, critical group and death group after7days glucocorti-coid treatment has statistical difference while survival group nosignificant difference.[Concluston]1. The critical patients improved significantly lower than the severe patients, and the fatality rate is higher than the severe cases;2. When below symptoms appear such as increased respiratory rate, heart rate, unconsciousness, cyanosis, pulmo-nary rales upon the first diagnosis and the laboratory examination and imaging showi-ng that the patients white blood cell count increased, neutrophil ratio increased, the ratio of lymphocyte reduced, AST, LDH increased, Na reduce, PT, APTT prolong,extent of disease than lung field1/2, pleural effusion; When below symptoms appear such as disease increase, the patients’body temperature significantly increased>38℃, resp-iratory rate increased>30beats/min, heart rate>121beats/min, a disturbance of cons-ciousness and cyanosis during the disease pathogenesis; and laboratory examination and imaging shows that neutrophil ratio increased, decreased platelet count, extent of disease than lung field1/2, and when patients with pneumothorax or mediastinal emphysema, ARDS, acute renal failure, liver damage, secondary infection, DIC, the possibility of patients develop from severe to critical and the risk of patients develop from critical to death should be alerted. But whether this is an independent risk factor, it should be subject to further large sample and multi-center randomized study to clear.3.The application of glucocorticoids for severe、critical illness and even fatal cases is beneficial to the patient’s body temperature, while no difference for survival group patients.