Analysis of clinical and lung imaging features of influenza A H1N1 cases of severe disease reportWord文档下载推荐.docx

Analysis of clinical and lung imaging features of influenza A H1N1 cases of severe disease reportWord文档下载推荐.docx

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[Abstract]ObjectiveToimproveunderstandingofthecharacteristicsofinfluenzaA（H1N1）casesofseverediseaselungimaging.AnalysisofthreecasesofseverecasesofInfluenzaA（H1N1）clinicaldata,andanalysisoflungimagingfeatures.ThreecasesofpatientswithchestCTvaryingdegreesoflunginjuryinthecaseofachestCTfindingsofleftlung,lowerlobeblockbustersexudativedenseshadowoftherightlowerlobecanbeseenalittleoozingshadow,irregularborder.Example2chestCTshowedarightlungleafexudateshadowsscatteredinmultiplefoci.casesofchestCTperformanceforthenextbilateralpulmonaryexudativelesions,mainlyinthelowerlobe3casesclinicalmanifestationswerefever,coughandchesttightnesssymptoms,hypoxiaviremiaandleukopenia3casesweregivenantibioticsandoseltamivirtreatmenttogoodeffect,discharged.Conclusion（H1N1）casesofinfluenzawithseverelungimagingperformanceofmultiplelesionsmainlybilateralinthelowerlobetoinfiltrationsexoutoftheshadowofthemain,sometimesalittleinterstitialchange,thelesionsshowedadiversitycharacterizedtherapidprogressofanti-inflammatoryiswellabsorbedafterantiviraltherapy.

[Keywords:

]influenzavirustypeA,H1N1subtype;

pneumonia;

Tomography,X-raycomputed[ABSTRACT]ObjectiveToraisetheunderstandingoflungimagefeaturesinseverepatientswithinfluenzaAH1N1.MethodsAnanalysiswasdoneforclinicaldataofthreepatientswithsevereH1N1influenzaAandtheirfeaturesoflungimage.ResultsAchestCTscanofthethreepatientsshowedvariousextentsoflunginjuries:

Incase1,massivelyexudativedensesha-dowofmiddleandlowerlobesofleftlung,andalittleeffusionoflowerlobeintherightlungwithirregularityboundarycouldbeseen;

Incase2,exudativeshadowinlowerlobeofrightlung,characterizedasdisseminatemultiplelesions;

Incase3,exudativefocusinbilaterallungs,withmainlyinmiddleandlowerlobe.Themanifestationsofthosethreecaseswerethesame:

fever,cough,chestdistress,hyoxemia,andleucopenia.Theyweregivenantibioticsandoseltamivirwithagoodoutcomeandrehabilitationdischarged.ConclusionThemainmanifestationsoflungonCTinpatientswithsevereH1N1influenzaAaremultiplelesionsinmiddleandlowerlobesofbilaterallungswithfastdevelopment,whichcharacterizedmainlyaseffusionoralittlemesenchymalchanges.Thelesionsrespondwelltoanti-inflammatoryandantiviraltherapy.

[KEYWORDS]influenzaAvirus,H1N1subtype;

tomography,X-raycomputedInfluenzaAH1N1influenzaglobalpandemic,broadcasttoover200countriesandregions,thecurrentoutbreakiseasingphaseofthisacuterespiratoryinfectiousdiseasecausedbytheH1N1influenzavirus,theearlysymptomsaresimilartonormalseasonalinfluenza,mainlyfever,cough,sorethroat,malaise,headacheandfatigue,flu-likesymptoms,mostofthegoodprognosispartofthepatient’sconditioncanrapidlyprogress,ferocious,andasuddenhighfever,atemperatureover39°

C,andevensecondarytoseverepneumonia,acuterespiratorydistresssyndrome,pulmonaryhemorrhage,pancytopenia,renalfailure,sepsis,shock,respiratoryfailureandmultipleorgandamageleadingtodeath.hospitalsuccessfullytreatedthreecasesofinfluenzaA（H1N1）casesofseveredisease,nowtheclinicaldataandliteratureThereportisasfollows.

1clinicaldataExample1,female,11yearsold.October17,2009withfever,coughaccompaniedbychesttightness,bodytemperature39.5°

C,athometreatment,symptomsdidnotimprove.October22tothefeverclinicofahospital,themeasuredbodytemperatureof40.5°

C,thedateofhospitalization.ChestDRchecksshowedtheleftlowerlungfieldcoarsetexturedisorder,middlemediastinum,bilateralribeveryanglenoabnormalblood:

theWBC2.6×

109/L.previousnine-yearhistoryofasthma,epilepsy,ahistoryofsevenyearsinthe10diagnosedasinfluenzaA（H1N1）casesofseverediseaseon23Maytoturnourhospitalforfurthertreatment.admissionexamination:

generallypoor,shortnessofbreath,tonsilIIdegree,in,underthelungscouldbeheardanddryrales.ChestCTacidissatisfied:

intheleftlung,lowerlobevisiblelargeareasofflocculentexudativeshadowoftherightlowerlobecanbeseenalittleoozingshadow.Bloodgasanalysisshowedhypoxemia.givenfurosemidewesttoeach1.0g,2adayintravenousinfusion;

antiviralsAustrianSecretaryWei,eachof100mgtwicedailytreatment;

aerosolinhalationRupumike,eachof1mg,2timesaday;

takingantiepilepticdrugs.1026,ChestCTscanshowslungshadowsabsorptionisnotobvious,continuetogivetheanti-inflammatoryandantiviraltreatment.againreviewthechestCT,thelowerrightlung,leftlungmid-andlowerlobeeffusionshadowofapparentabsorption（seeFigure1a,b）.

Example2,female,13yearsold.October24,2009fever,runnynose,sorethroat,headache,cough,bodytemperatureupto39.9°

ConOctober26thtogotoahospitalfeveroutpatientchestDR-rayexaminationnoabnormalbloodtest:

WBC9.3×

109/L,neutrophils0.892.10January27,diagnosedasinfluenzaA（H1N1）criticallyillcasestoturnthehospitaladmissionexamination:

pharyngealhyperemia,bilateraltonsilIlarge,coarsebreathsoundsinbothlungs.isnotknownandthewetanddrytone.bloodtest:

WBC3.2×

109/Landneutrophils0.788.bloodgasanalysisshowedhypoxemiagiveceftriaxonesodium,each2.0g,2timesadayintravenously;

AustriaOseltamivireach100mgtwicedailytreatment.October30chestCTexaminationshowed:

rightlowerlobecanbeseenscatteredinexudativeshadow.tocontinuetreatmentuntilNovember3rdtoreviewchestCTshowsrightlungleavesexudativeshadowsabsorption（Figure2a,b）.

Example3,male,23yearsold,November20In2009,fever,runnynose,cough,bodytemperature39.9℃.November23,toahospitalfeveroutpatientchestDRfilmexaminationshowed:

lowerleftlungmarkings,bilateralribeveryanglesharp,middlemediastinum,initiallydiagnosedaspneumonia,receivedhospitaltreatment.November24,2009,thediseaseprogressesrapidlychesttightness,suffocation,significantlyworseaftertheevent.examination:

throatcongestion,tonsilⅠdegree,thelungscouldbeheardandscatteredmoistrales.Bloodgasanalysisshowedhypoxemiabloodtestsshowed:

WBCcount2.7×

109/L,lymphocytes0.335,bloodbiochemicaltestsshowedalanineaminotransferaseandaspartateaminotransferase,bloodglucoseincreased.11January25chestCTshowed:

bilaterallunginthelowerlobewereseenscatteredintheflocculentexudateshadow,adouble-lowerlobeobvious.tocontinueanti-inflammatorytreatment.November27reviewofchestCT:

lunglowerlobelesionsprogress,mainlyininterstitiallungdisease.TurnourhospitaldiagnosedasinfluenzaA（H1N1）criticallyillcases.AustrianSecretarytogiveantiviraldrugsoseltamivirtreatment,thedoseofeach150mg2timesaday;

tocontinueanti-inflammatoryandsymptomatictreatmentof.11onthe30thagaintoreviewthechestCT:

absorptionofleaflesionsonthelungs,lung,lowerlobeseetheshadowofthecord-likeabsorptionisnotobvious.DecemberreviewofchestCTinthe4th:

lunglesionsabsorption（Figure3a,b）.Figure1CTofapatient’sperformanceFigure2casesof2patientswithCTfindingsofFigure3casesof3patientstheCTfindings

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discussionH1N1influenzavirusisavirusfamilyissticky,influenzavirus,itspreadbetweenpeoplemorevulnerabletoinfectionthanseasonalinfluenza,stronger,childrenandyoungadults,butalsoinmanycountriesaroundtheworldcontinuedtospread.Mildpatientstothecommunityorhomeisolationandtreatment,hospitaltreatmentandhometreatmenteffectdifferences[1-2],butwithcomplicationsrequiringhospitalization,andlongerhospitalstay,especiallythosewithlungdiseaseandheartdisease,diabetesorpatientsundergoingimmunosuppressivetherapyinourhospitalfromthreecasesofInfluenzaA（H1N1）casesofcriticallyillpatients,clinicalmanifestationsarefever,coughaccompaniedbychesttightnessandearlyonsetoflungX-rayexaminationwerenormal,asthediseaseprogresseschestCTscanshowedthelungtothelowerlobeofthemainexudativelesions,extentofdiseasewassporadic,interstitialchangesafterthe3casesofpatientsadmittedtohospitalweregivenantibioticsandantiviraldrugs,andsymptomatictreatment.AustriaOseltamivirasneuraminidaseinhibitorspreventsneuraminidaseresiduesdivision,theinterferenceofinfluenzavirusreplicationanddistributioninthemucosalsecretions,reducetheactivityofthevirusinfectionduringtreatmentnoadversereactionsoccur.patientsappearedgranulocytesduringtreatmentreducedanalysisandvirusinfectionandoraloseltamivirtreatmentrelatedtocompletionoftreatmentwerenormalinstableconditionafterthereview,thisneutropeniapresentsa.

ChestCTcanprovidemorelesionsthanchestDRtabletssignsofpulmonarylesionsmoreclearlyshowtheDR-chipinterferencebymanyfactors[3]andclinicalcasesofcriticallyillpatientsinthetreatmentperiod,inatimelymannerforchestCTchecktoaccuratelydeterminethescopeofthelungs,theextentoflungdamage,aswellasthesiteofdamage,withorwithoutcomplications,suchaschestX-rayfilmisdifficulttoshowtheheartshadoworparaspinallesions,chestCTcanbeeasilyshowTherefore,chestCTscanhassomeadvantages