探讨重症及危重症甲型H1N1流感病毒性肺炎患者临床诊断学特征与治疗特点。

收集2019年1至2月云南省传染病医院内科重症监护病房收治的6例重症及危重症甲型H1N1流感病毒性肺炎患者的临床资料，并进行回顾性分析。

主要症状是发热、咳嗽(6/6)，其次是呼吸困难及血痰(4/6)。中性粒细胞比例、降钙素原、乳酸脱氢酶水平升高5例，淋巴细胞计数降低3例，CD4^＋淋巴细胞计数降低2例，6例C反应蛋白水平均升高，脑利钠肽前体、D-二聚体水平升高4例，丙氨酸氨基转移酶、天冬氨酸氨基转移酶水平升高3例，血肌酐水平升高2例。支气管肺泡灌洗液及抽吸痰培养结果显示，近平滑假丝酵母菌、鲍曼不动杆菌、产吲哚金黄杆菌和粘质沙雷菌各1例。6例患者影像学表现均异常，均是双侧浸润影伴毛玻璃样改变，伴条索状、网状等间质性阴影，以中下叶及肺外带为主。给予抗感染、免疫调节剂及激素、呼吸机辅助呼吸、连续性静脉-静脉血液滤过透析、肺灌洗等治疗。6例患者均康复出院，2例双下肺背段残留少部分网格状增殖纤维病灶。

早期识别、及时有效抗病毒治疗、减少继发细菌和真菌感染是重症及危重症甲型H1N1流感病毒性肺炎救治的关键。

To explore the clinical diagnostic features and therapeutic status of severe and critical influenza A(H1N1)viral pneumonia.

The clinical data of 6 patients of severe and critical influenza A(H1N1) viral pneumonia were analyzed retrospectively from January to February 2019 in Medicine Intensive Care Unit (ICU) of Infectious Disease Hospital of Yunnan Province.

All of the 6 patients had fever and cough (6/6), and followed by dyspnea and bloody sputum (4/6). The levels of neutrophil percentage, procalcitonin(PCT) and lactate dehydrogenase (LDH) elevated in 5 patients. Lymphocyte count decreased in 3 cases, CD4⁺ lymphocyte count decreased in 2 cases, c-reactive protein (CRP) levels elevated in 6 cases. Four patients had elevated N-terminal pro-brain natriuretic peptide (Nt-proBNP) and D-dimer levels, 3 patients had elevated alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels, and 2 patients had elevated creatinine levels. Bronchoalveolar lavage fluid (BALF) and endotracheal aspirate culture showed that there were 1 patient of Candida Parapsilosis, 1 patient of Acinetobacter BaumannⅡ, 1 patient of Chryseobacterium Indologenes and 1 patient of Chromobacterium Prodigiosum. Chest CT examination showed that in all of the 6 patients, multiple infiltration and ground-glass, with streaky and netty equi-interstitial shadows in bilateral lungs, mainly in the lower-middle lobe and extrapulmonary zone. All patients were treated with anti-infection, immunomodulator, corticosteroids, mechanical ventilator assisted ventilation, continuous venous-venous hemodiafiltration (CVVHDF) and lung lavage therapy and so on. All of the 6 patients were cured, and the lower lung dorsal segment of 2 patients left over grid-like proliferative fibrous lesions.

Early identification, timely and effectively antiviral treatment, reduction of secondary bacterial and fungal infections are the keys to the treatment of severe and critical viral pneumonia of influenza A (H1N1).