肺部超声在重症人感染H7N9禽流感中的应用研究

Application of pulmonary ultrasound in severe human infection with H7N9 avian influenza

目的探讨肺部超声在评估重症人感染H7N9禽流感患者病情严重程度及预后中的价值。方法选取近期收治的1例重症人感染H7N9禽流感并ARDS病例为研究对象,由同一位观察者每日予患者肺部超声检查及肺通气超声评分,间断行床旁胸片及胸部CT检查,对比分析影像学特点,收集每日体温、C反应蛋白(CRP)、白细胞计数(WBC)、肺泡-动脉氧分压差(A-a DO_2)、氧合指数、淋巴细胞计数、急性生理与慢性健康评分(APACHE-Ⅱ)及临床肺部感染评分(CPIS)资料,分析临床指标与肺通气超声评分之间的关系。结果随着病情改善,体温、CRP、WBC、A-a DO_2、CPIS评分、APACHE-II评分逐渐下降,氧合指数、白细胞、淋巴细胞逐渐升至正常,胸片和CT提示肺部病变范围逐渐减小,同期肺部超声征象发生相应的改变,肺通气超声评分与临床指标变化趋势基本一致。结论肺部超声可实时动态反应肺部病变,在评估重症人感染H7N9禽流感并ARDS患者病情严重程度及预后中具有重要应用价值。

Objectives To evaluate the value of pulmonary ultrasound in evaluating the severity and prognosis of severe human H7N9 avian influenza.Methods One case of severe human infection with H7N9 avian influenza and ARDS was selected as the study object.The same observer was given the pulmonary ultrasound examination and the lung ventilation ultrasound score daily,the chest radiography and chest CT examination were performed intermittently,and the imaging features were compared and analyzed.The data of daily body temperature C-reactive protein(CRP),white blood cell count(WBC),alveolar-arterial partial pressure of oxygen(A-aDO2),oxygenation index,lymphocyte count,acute physiological and chronic health score(APACHE-II)and clinical pulmonary infection score(CPISs)were collected to analyze the relationship between clinical indexes and ultrasonic score of pulmonary ventilation.Results With the improvement of the state of illness,the CPIS score of CRPU WBCU A-aDO2CPIS and APACHE-II decreased gradually,the oxygenation index,white blood cells and lymphocytes gradually increased to normal.Chest radiographs and CT showed that the range of pulmonary lesions gradually decreased,and the corresponding changes occurred in the same period,and the pulmonary ventilation ultrasound scores were basically consistent with the changes of clinical indexes.Conclusions Pulmonary ultrasound can respond to pulmonary lesions dynamically and in real time.It has important application value in evaluating the severity and prognosis of severe human infection with H7N9 avian influenza and ARDS.