新型甲型H1N1流感重症患者肺部影像学变化及临床特点

目的 探讨新型甲型H1N1流感(简称甲型流感)危重病例肺部影像学的变化及其临床特点. 方法 山西省太原市第四人民医院2009年10月20日至11月22日收治的10例重症甲型流感确诊患者,男6例,女4例,年龄5～41岁,平均19.3岁.采用常规技术检测血常规、血气指标、肝肾功能及心肌酶学变化,并行胸部X线及CT检查;给予奥司他韦、吸氧、呼吸支持、抗感染及对症支持等综合治疗. 结果 患者均以发热、咳嗽、呼吸困难为主要症状,肺部病灶表现多种多样,表现为磨玻璃影及实变影、肺不张、液气胸及胸腔积液等征象,进展快,同时存在急性肺炎和急性间质性肺炎的影像学改变,10例中5例发展为急性肺损伤,3例发展为ARDS;奥司他韦、呼吸支持及抗感染治疗有效. 结论 甲型流感危重病例的影像学表现为急性肺炎和急性间质性肺炎改变,临床表现为病情重、进展快,可发展为ARDS.

The changes of chest imaging and clinical features in patients with severe infection of new influenza A (H1N1)

Objective To study the clinical features and the pulmonary imaging changes of severe cases of new influenza A(H1N1). Methods This study included 10 severe cases with new influenza A (H1N1)infection in the Forth People's Hospital of Taiyuan from 20 Oct. 2009 to 22 Nov 2009.Six patients were males and 4 were females,with an average age of 19.3 years(range 5-41 years).The laboratory study included blood routine.blood gas analysis,liver and renal function tests,myocardium enzymology,chest radiograph and CT. Results The prominent clinical features included fever.cough and dyspnea.The pulmonary imaging changes were varied,including ground-glass opacity,consolidation,atelectasis,fluid pneumothorax and pleural effusion,and manifestations of acute pneumonia and interstitial pneumonia simultaneously.Extensive pulmonary infiltration developed quickly,and acute lung injury(ALI)Occurred in 5 patients and acute respiratory distress syndrome(ARDS)in 3 cases.Oseltamivir,oxygen therapy and antibiotic therapy were effective for improvement of the disease and final recovery of all these patients. Conclusions The severe cases of new influenza A (H1N1) infection has imaging manifestations of acute pneumonia and interstitial pneumonia.The disease progresses quickly and may lead to ALI/ARDS.