Objective: To observe clinical features of severe influenza A H1N1 in Qinghai Province.
Methods: The clinical data of 75 severe influenza A H1N1 patients were analyzed retrospectively in regard to common features, clinical symptoms, signs, laboratory data and treatments hospitalized in Qinghai Hospital for Infectious Diseases during September 4, 2009 to December 31, 2009.
Results: The first case with severe influenza A H1N1 was diagnosed on October 14, and up to 75 patients (47.78%) on December 31. Among 75 patients, 45 patients were from rural areas (60.00%) and 30 patients were urbanites, 48 patients were male, and 27 female. Fifty-three patients were complicated with pneumonia (70.67%) and 41 patients with pre-existing medical conditions (54.67%), 65 patients with fever (86.67%), 63 patients with cough and sputum (84.00%), 61 patients with dyspnea (81.33%), 1 patients with meningitis as the main manifestation, 2 patients with acute pulmonary edema and left heart failure, 28 patients with leucopenia (37.33%), 28 patients with myocardial enzyme abnormalities (37.33%), 23 patients with blood glucose abnormalities (30.67%), 8 patients with coagulopathy (10.67%), 4 patients with lipid abnormalities (5.33%), 51 patients with increased C-reactive protein (68.00%). Forty-eight patients received oseltamivir, 27 patients received anti-virus "Jun Ke Ao Wei" capsules. Low molecular weight heparin was given to 27 patients for anticoagulation, and 22 were treated with methylprednisolone. In 33 patients who underwent non-invasive mechanical ventilation, among them it was switched to invasive mechanical ventilation in 10 patients. Second-line antibiotics were used, and sputum culture was done. In 8 patients with fungal infection anti-fungal therapy was given. Except 1 patient out of 75 patients died, and the rest were cured.
Conclusion: In Qinghai Province, cases with influenza A H1N1 peaked early with relative high incidence of severe cases. Patients suffering from influenza A H1N1 are susceptible to pulmonary complications. The condition of patients rapidly deteriorate, and they are prone to develop respiratory failure, disseminated intravascular coagulation and multiple organ failure.