CAJ | 학술논문

目的分析甲型H1N1流感合并肺炎患者的临床特点,探讨其诊断和救治方法.方法对中国医科大学附属盛京医院急诊科确诊的39例甲型H1N1流感合并肺炎患者的流行病学资料、临床表现、实验室检查、胸部X线或肺部CT表现进行回顾性分析.结果 39例甲型H1N1流感合并肺炎患者中,男17例,女22例;18～59岁36例(92.31%).流行病学资料显示,39例患者均无明确的与发病期甲型H1N1流感确诊病例密切接触史.临床症状有发热(100%)、咳嗽(58.97%)、咽痛(38.46%)、乏力(28.21%)等.实验室检查:血白细胞计数正常或低于正常28例(71.79%),心肌酶谱异常主要表现为肌酸激酶升高(58.97%),肝功能异常主要表现为天冬氨酸氨基转氨酶升高(43.59%),重症患者血气分析提示急性肺损伤(12.82%).胸部X线或肺部CT表现为从散在多叶或段炎症到单侧肺或双侧肺内中带可见大片状高密度影.结论有发热症状,肺炎影像学短时间内动态改变并迅速恶化,动脉血气分析迅速表现出低氧血症,肌酸激酶和天冬氨酸氨基转氨酶升高时,要高度疑诊甲型H1N1流感重症病例,经甲型H1N1流感病毒核酸检测可诊断为甲型H1N1流感合并肺炎病例.奥司他韦为首选抗病毒药,给予综合支持对症治疗,早期氧疗、尽早使用呼吸机治疗是降低甲型H1N1流感合并肺炎危重病例病死率的关键.
목적 분석갑형H1N1류감합병폐염환자적림상특점,탐토기진단화구치방법.방법 대중국의과대학부속성경의원급진과학진적39례갑형H1N1류감합병폐염환자적류행병학자료、림상표현、실험실검사、흉부X선혹폐부CT표현진행회고성분석.결과 39례갑형H1N1류감합병폐염환자중,남17례,녀22례;18～59세36례(92.31%).류행병학자료현시,39례환자균무명학적여발병기갑형H1N1류감학진병례밀절접촉사.림상증상유발열(100%)、해수(58.97%)、인통(38.46%)、핍력(28.21%)등.실험실검사:혈백세포계수정상혹저우정상28례(71.79%),심기매보이상주요표현위기산격매승고(58.97%),간공능이상주요표현위천동안산안기전안매승고(43.59%),중증환자혈기분석제시급성폐손상(12.82%).흉부X선혹폐부CT표현위종산재다협혹단염증도단측폐혹쌍측폐내중대가견대편상고밀도영.결론 유발열증상,폐염영상학단시간내동태개변병신속악화,동맥혈기분석신속표현출저양혈증,기산격매화천동안산안기전안매승고시,요고도의진갑형H1N1류감중증병례,경갑형H1N1류감병독핵산검측가진단위갑형H1N1류감합병폐염병례.오사타위위수선항병독약,급여종합지지대증치료,조기양료、진조사용호흡궤치료시강저갑형H1N1류감합병폐염위중병례병사솔적관건.
Objective To analyze the clinical features of patients with both Influenza A(H1N1) and pneumonia.Methods The epidemiologic data,clinical manifestations,laboratory examination results,and chest X-ray/CT findings of confirmed patients in our department were retrospectively analyzed.Results Totally 39 confirmed patients (17 men and 22 women) were enrolled.All patients had no definite history of close contact with Influenza A(H1N1) patients.The clinical manifestations include fever (100%),cough (58.97%),pharyngalgia (38.46%),debilitation (28.21%).Laboratory examinations showed that white blood cell count was normal or lower than the normal level (71.79%),creatine kinase increased (58.97%),and aspartate aminotransferase increased (43.59%);artery blood gas analysis showed acute lung injury (12.82%).Chest X-ray/CT showed scattered multi-lobe or multi-segment inflammations or large patchy high-density shadow in lung.Conclusion The definite diagnosis can be made after Influenza A(H1N1) virus nucleic acid is detected.Oseltamivir is effective in treating Influenza A(H1N1).Inhalation of oxygen and application of respirator should be timely arranged to reduce the mortality of severe Influenza A(H1N1) combined with pneumonia.