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目的 探讨高原地区甲型H1N1流感重症、危重症患者的救治特点.方法 选择本院2009年10月10日至12月19日重症监护病房(ICU)收治的8例甲型H1N1流感患者,重症4例、危重症4例.经抗病毒、抗生素、激素、增强免疫功能、调节水和电解质平衡及对症支持、机械通气治疗后,分析高原地区甲型H1N1流感的治疗特点.结果 8例患者均给予抗病毒药奥司他韦、抗生素莫西沙星加头孢曲松或头孢哌酮治疗;液体补充应掌握宁干勿湿的原则;3例重症和3例危重症患者给予氢化可的松,1例危重症患者给予甲泼尼龙;7例患者根据病情给予丙种球蛋白.4例患者行无刨机械通气,给予双水平气道正压通气(BiPAP)或持续气道正压通气(CPAP),病情得到有效控制;1例危重症患者因病情需要行有创机械通气,初期行同步间歇指令通气(SIMV)+压力控制通气(PCV)+高呼气末正压(PEEP)通气模式,后改为自主呼气模式+压力支持通气(PSV)+低PEEP行脱机前治疗.最终成功拔除气管插管脱离有创通气治疗.8例患者均治愈出院.结论 对高原甲型H1N1流感重症、危重症患者应短期、足量、规范应用激素、及早给予无创机械通气治疗.

Objective To discuss the strategy of treatment of critically ill influenza A H1N1 patients in plateau region.Methods Four seriously ill and 4 critically ill patients suffering from influenza A H1N1 were admitted to the intensive care unit during October 10th through December 19th 2009.They were treated with antivirus drug,antibiotics,corticosteroid,measures to enhance immune function,fluid and electrolyte supplementation,symptomatic treatment,and mechanical ventilation.With their clinical data the distinguishing features in the treatment of these patients were analyzed.Results Oseltamivir as an antivirus drug,and moxifloxacin together with ceftriaxone or cefoperazone were given to all the patients.Fluid replacement was controlled to avoid over hydration.Corticosteroid was administered to 3 seriously ill patients and 3 critically ill patients.Methylprednisolone was given to 1 critically ill patient.γ-globulin was given to 7 patients.Four patients underwent atraumatic mechanical ventilation with bi-level positive airway pressure (BiPAP)or continuous positive airway pressure(CPAP)with good result.Owing to deterioration in respiratory function,traumatic mechanical ventilation was instituted in a critically ill patient,primarily with synchronized intermittent mandatory ventilation(SIMV)+pressure support ventilation(PSV)+high positive end expiratory pressure(PEEP).The condition of the patient was improved,and ventilation modality was changed to spontaneous respiration+PSV+low PEEP before weaning.Finally the patient was weaned from respirator successfully.All the 8 patients survived and discharged from the hospital.Conclusion Short term,full dosage of corticosteroid should be given to seriously ill and critically ill influenza A H1N1 patients according to specification,and atraumatic mechanical ventilation should be installed early in the treatment.