流行性感冒合并肺炎临床特征分析

目的探讨流行性感冒合并肺炎患者的临床症状、治疗及预后以加深对流行性感冒合并肺炎的了解。 方法回顾性分析2017年11月至2018年3月就诊于解放军总医院的甲型流行性感冒合并肺炎68例、乙型流行性感冒合并肺炎66例患者的临床症状、辅助检查、治疗方法及预后情况。 结果高热、乏力、干咳为流行性感冒合并肺炎最主要的首发症状，乙型流行性感冒合并肺炎患者既往患有糖尿病、支气管扩张病史的比例高于甲型流行性感冒合并肺炎，流行性感冒合并肺炎最易感染鲍曼不动杆菌及曲霉菌。9例(13.2%)甲型流行性感冒合并肺炎和5例(7.6%)乙型流行性感冒合并肺炎累及左肺，对其进行统计分析发现甲型流行性感冒合并肺炎和乙型流行性感冒合并肺炎在累及部位上无明显统计学意义。9例(13.2%)甲型流行性感冒合并肺炎和10例(15.2%)乙型流行性感冒合并肺炎合并胸腔积液；8例(11.8%)甲型流行性感冒合并肺炎和11例(16.6%)乙型流行性感冒合并肺炎11例仅表现为片状磨玻璃影；49例(72.0%)甲型流行性感冒合并肺炎和7例(10.2%)乙型流行性感冒合并肺炎7例(10.2%)表现为片状磨玻璃影和实变同存。7例(10.2%)甲型流行性感冒合并肺炎和11例(16.7%)乙型流行性感冒合并肺炎11例死亡。甲型流行性感冒合并肺炎和乙型流行性感冒合并肺炎在治疗、预后上无明显统计学差异(P>0.05)。 结论流感高发季，如老年人出现高热、干咳、乏力等症状，生化提示乳酸脱氢酶升高，肺CT提示双肺弥漫性间质渗出、实变，应高度警惕流行性感冒合并肺炎的发生，早期进行治疗干预，乙型流行性感冒合并肺炎死亡率不低于甲型流行性感冒合并肺炎。

Clinical characteristics of post-influenza pneumonia

ObjectiveTo summarize the clinical symptoms, treatment and prognosis of the patients with post-influenza pneumonia in order to deepen the understanding of post-influenza pneumonia. MethodsA retrospective analysis was made on the clinical symptoms, auxiliary examinations, treatment and prognosis of 68 cases of post-influenza A pneumonia and 66 cases of post-influenza B pneumonia in PLA General Hospital in Beijing from November 2017 to March 2018. ResultsHyperpyrexia, fatigue and dry cough were the most common first symptoms of post-influenza pneumonia. The proportion of the patients with post-influenza B pneumonia suffering from previous diabetes mellitus and bronchiectasis was higher than that of the patients with post-influenza A pneumonia. Post-influenza pneumonia was most likely to be associated with acinetobacter baumannii and aspergillus infection. A statistical analysis of 9 cases (13.2%) of post-influenza A pneumonia and 5 cases (7.6%) of post-influenza B pneumonia involving the left lung found that post-influenza A pneumonia and post-influenza B pneumonia had no statistical significant difference in the area involved. Pleural effusion was found in 9 cases (13.2%) of post-influenza A pneumonia and 10 cases (15.2%) of post-influenza B pneumonia. Flake-like glass shadow was found only in 8 cases (11.8%) of post-influenza A pneumonia and 11 cases (16.6%) of post-influenza B pneumonia. Forty-nine cases (72.0%) of post-influenza A pneumonia and 7 cases (10.2%) of post-influenza B pneumonia were characterized by the existence of flake-like ground glass shadow and real change (χ²=54.278, P<0.01), with statistical significant difference. Seven cases (10.2%) of post-influenza A pneumonia and 11 cases (16.7%) of post-influenza B pneumonia were died. There was no significant difference in the treatment and prognosis of post-influenza A pneumonia and post-influenza B pneumonia (P>0.05). ConclusionDuring the influenza epidemic period, if the symptoms, such as hyperpyrexia, dry cough and fatigue in the elderly, increase the lactate dehydrogenase and pulmonary CT shows diffuse interstitial exudation and consolidation in both lungs, we should be highly alert to the occurrence of post-influenza pneumonia and make early treatment and intervention. The mortality rate of post-influenza B pneumonia is not less than that of post-influenza A pneumonia.