11例以重症肺炎为首发表现人感染H7N9禽流感临床分析.docVIP

11例以重症肺炎为首发表现的人感染H7N9禽流感临床分析 　　[摘要] 目的 了解湖州地区人感染H7N9禽流感确诊病例的临床特征及影像学特点。 方法 选择2013年4月1日～2014年10月30日的11例人感染H7N9禽流感确诊病例，对其进行临床特征与影像学分析。 结果 人感染H7N9禽流感临床表现主要为发热、咳嗽、咳痰，研究中11例患者均有发热，其中4例痰中带血丝，4例腹泻，6例胸闷、气促。多数患者有家禽接触史，卡他症状少见，55.0%患者出现呼吸衰竭，起病至呼吸衰竭平均时间5.0 d。肺部CT病变主要在下叶背段、后基底段，上叶尖后段、舌段，病灶进展期变化迅速，部分患者恢复期即使临床症状消失，但肺部仍有片状高密度影。 结论 人感染H7N9禽流感容易出现重症肺炎，呼吸衰竭，尽早服用奥司他韦抗病毒，将有效减轻病情，避免严重并发症发生。提高对人感染H7N9禽流感患者的临床特征与影像学特点认识，将有利于该病的及时诊断与预后评估。 　　[关键词] 流感病毒A型；H7N9亚型；禽流感；重症肺炎；临床特征；奥司他韦 　　[中图分类号] R969.3 [文献标识码] B [文章编号] 1673-9701（2016）24-0034-04 　　1.Department of Respiratory Medicine， Huzhou Central Hospital in Zhejiang Province， Huzhou Hospital of Zhejiang University， Huzhou 313000， China； 2.Department of Infectious Disease， Huzhou Central Hospital in Zhejiang Province， Huzhou Hospital of Zhejiang University， Huzhou 313000， China； 3.Department of Radiology， Huzhou Central Hospital in Zhejiang Province， Huzhou Hospital of Zhejiang University， Huzhou 313000， China 　　[Abstract] Objective To explore the clinical and radiological features of patients infected with H7N9 bird flu in Huzhou. Methods The clinical and radiological features of 11 patients infected with H7N9 bird flu from April 1， 2013 to October 30， 2014 were analyzed. Results The clinical features of human infection of H7N9 were mainly fever， coughing， and expectoration. 11 cases had fever， 4 cases had blood streak in sputum， 4 cases had diarrhea， and 6 cases had chest distress and shortness of breath. Most of the patients had a history of poultry contact. Catarrh symptoms were rare. 55.0% of the patients experienced respiratory failure， with an average duration of 5.0 days. The lesions in lung were mainly at dorsal segment of lower lobe， posterior basal segment， and posterior segment and lingular segment of supper lobe apex as shown by CT. The lesions changed rapidly at the progressive stage， and in some patients， high density shadow could still be observed in lungs even at the recovery stage when there was no clinical symptom. Concl