31例重症和危重症甲型H1N1流感患者的临床与影像学表现特点

Clinical and imaging characteristics of novel influenza A (H1N1) infection in 31 severe and critically ill patients

目的:探讨重症和危重症甲型H1N1流感患者的临床与影像学表现特点。方法:回顾性分析31例重症和危重症甲型H1N1流感患者的临床表现及胸部影像学资料。其中重症甲型H1N1流感患者19例,平均(15.9±5.6)岁,体重指数(BMI)平均19.3±4.2。危重症患者12例,平均(23.5±13.6)岁,BMI平均22.2±5.5。结果:重症和危重症患者均有发热、咳嗽、咳痰、乏力等症状,两肺可闻及湿啰音、哮鸣音?V刂⒆榛颊咄怀霰硐治粑?少数出现胸痛、紫绀及咳血痰。重症组有肺炎病灶17例,影像表现均为斑点片状影,两肺受累7例,累及全肺2例,急性肺损伤3例;危重症组患者均有肺炎病灶,斑点片状影4例,大片状阴影8例,双肺受累9例,累及全肺7例,超过2/3的患者发生重症肺炎、中重度低氧血症、急性肺损伤/急性呼吸窘迫综合征(ARDS)和呼吸衰竭。结论:发热、咳嗽及咳痰等仍然是重症和危重症甲型H1N1流感患者的临床特征。高危人群感染甲型H1N1流感病毒后较易发展为重症或危重症病例。有基础疾病的患者在出现持续发热的同时,两肺见广泛磨玻璃密度影及大片状实变影,应警惕ARDS或病毒性肺炎合并细菌或真菌感染。

Objective:To investigate the clinical and imaging characteristics of novel influenza A (H1N1) infection in severe and critically ill patients.Methods:The clinical and thoracic imaging materials of 31 severe/critical patients with novel influenza A (H1N1) infection were retrospectively analyzed.There were 19 severe cases with the mean age as 15.9±5.6 years old,body mass index (BMI)19.3±4.2;of the 12 critically ill cases,the mean age was 23.5±13.6 years old,BMI was 22.2±5.5.Results:The main signs and sysptoms were fever,cough,expectoration,fatigue;moist rales and wheezing sound on auscultation.Dyspnea was the distinct manifestation in critically ill patients.A few patients had chest pain,cyanosis and bloody sputum.For patients in severe group,pneumonia were found in 17 patients with the imaging findings as spotty and patchy opacities involving bilateral lungs (7 cases),all pulmonary lobes (2 cases);acute lung injury (ALI) was assessed in 3 cases.All of the critically ill patients had pneumonia,with spotty and patchy opacities in 4 cases,large patchy opacities in 8 cases,involving bilateral lungs in 9 cases and all pulmonary lobes in 7 cases.More than 2/3 of the patients had severe pneumonia,hypoxemia (mild/severe),ALI/acute respiratory distress syndromes (ARDS) and respiratory failure.Conclusion:Fever,cough and expectoration were the clinical features of novel influenza A (H1N1) infection in severe and critically ill patients.Influenza A (H1N1) in high risk population are apt to develope severe and critical illness,ARDS or viral pneumonia complicated with bacterial or fungal infection should be alerted when patients had underlying diseases,with sustained fever,extensive GGOs and large patchy consolidations.