CAJ | 학술논문

目的研究甲型H1 N1流感合并急性呼吸窘迫综合征患者出院后1年的肺功能和肺部影像学改变，探讨长期肺部病变与住院期间病情的关系。方法建立24例甲型H1 N1流感合并急性呼吸窘迫综合征的随访队列，在出院后1年[（12±1）个月]进行肺功能检测和胸部高分辨CT检查，回顾分析患者住院期间疾病严重程度、机械通气参数及肺部影像特点，分析长期改变与患者急性期病情的关系、随访期胸部CT与肺功能异常的关系。结果24例患者恢复期存在胸部CT异常者11例，其中网格样改变者11例、磨玻璃样改变者3例、局部肺气肿3例。恢复期肺功能障碍常见，13例（54.2％）仍有肺功能异常，其中8例（33.3％）存在弥散功能障碍，5例（25.8％）存在阻塞性通气障碍，3例（12.5％）存在混合性通气障碍（阻塞性＋限制性），7例（29.2％）存在通气储备功能下降。胸部CT异常者中肺功能异常明显高于胸部CT正常者（ P＜0.05）。结论甲型H1 N1流感危重症患者出院1年后，胸部CT异常和肺功能障碍仍较为常见，应重视对此类患者进行胸部HRCT和肺功能检查，以指导长期治疗。
목적연구갑형H1 N1류감합병급성호흡군박종합정환자출원후1년적폐공능화폐부영상학개변，탐토장기폐부병변여주원기간병정적관계。방법건립24례갑형H1 N1류감합병급성호흡군박종합정적수방대렬，재출원후1년[（12±1）개월]진행폐공능검측화흉부고분변CT검사，회고분석환자주원기간질병엄중정도、궤계통기삼수급폐부영상특점，분석장기개변여환자급성기병정적관계、수방기흉부CT여폐공능이상적관계。결과24례환자회복기존재흉부CT이상자11례，기중망격양개변자11례、마파리양개변자3례、국부폐기종3례。회복기폐공능장애상견，13례（54.2％）잉유폐공능이상，기중8례（33.3％）존재미산공능장애，5례（25.8％）존재조새성통기장애，3례（12.5％）존재혼합성통기장애（조새성＋한제성），7례（29.2％）존재통기저비공능하강。흉부CT이상자중폐공능이상명현고우흉부CT정상자（ P＜0.05）。결론갑형H1 N1류감위중증환자출원1년후，흉부CT이상화폐공능장애잉교위상견，응중시대차류환자진행흉부HRCT화폐공능검사，이지도장기치료。
Objective To evaluate the evolution of 24 patients with Influenza A ( H1N1 ) pneumonia and acute respiratory distress(ARDS),focusing our attention on patients with abnormal radiological findings and lung function change after 1 year.Methods 24 critically ill patients with novel Influenza A ( H1N1 ) in 2009 were returned a visit one year after hospital discharge .This study included interview , physical examination , chest HRCT scan and lung function test .The relationship between long-term change and condition of the past hospitalization was assessed.Results In 24 survival cases with novel influenza A ( H1N1) and ARDS,11 cases present with abnormal pulmonary CT after 1 year follow-up,including 11 cases with reticular pattern ,3 cases with ground-glass opacification and 3 cases with local emphysema .54.2%( 13/24 ) of cases with abnormal lung function , 33.3%( 8/24 ) with decreased DLCO ,25.8%( 8/24 ) with obstruction , 12.5%( 3/24 ) with combined obstructive-restrictive ventilation dysfunction .Lung function abnormal rate was more higher in cases with abnormal pulmonary CT than normal ( P<0.05 ) .Conclusion Chest CT abnormality and residual obstructive restrictive defects as well as impaired pulmonary gas exchange are common after severe novel influenza A (H1N1).It is necessary to suggest that those patients with ARDS are detected by chest HRCT scanning and lung function testing to guide patients long term care .