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

1、 Abstract Objective To improve understanding of the characteristics of influenza A （H1N1） cases of severe disease lung imaging. Analysis of three cases of severe cases of Influenza A （H1N1） clinical data, and analysis of lung imaging features. Three cases of patients with chest CT varying degrees of

2、 lung injury in the case of a chest CT findings of left lung, lower lobe blockbusters exudative dense shadow of the right lower lobe can be seen a little oozing shadow, irregular border. Example 2 chest CT showed a right lung leaf exudate shadows scattered in multiple foci. cases of chest CT perform

3、ance for the next bilateral pulmonary exudative lesions, mainly in the lower lobe 3 cases clinical manifestations were fever, cough and chest tightness symptoms, hypoxia viremia and leukopenia 3 cases were given antibiotics and oseltamivir treatment to good effect, discharged. Conclusion （H1N1） case

4、s of influenza with severe lung imaging performance of multiple lesions mainly bilateral in the lower lobe to infiltration sex out of the shadow of the main, sometimes a little interstitial change, the lesions showed a diversity characterized the rapid progress of anti-inflammatory is well absorbed

5、after antiviral therapy. Keywords: influenza virus type A, H1N1 subtype; pneumonia; Tomography, X-ray computed ABSTRACT ObjectiveTo raise the understanding of lung image features in severe patients with influenza A H1N1.MethodsAn analysis was done for clinical data of three patients with severe H1N1

6、 influenza A and their features of lung image.ResultsA chest CT scan of the three patients showed various extents of lung injuries: In case 1, massively exudative dense sha-dow of middle and lower lobes of left lung, and a little effusion of lower lobe in the right lung with irregularity boundary co

7、uld be seen; In case 2, exudative shadow in lower lobe of right lung, characterized as disseminate multiple lesions; In case 3, exudative focus in bilateral lungs, with mainly in middle and lower lobe. The manifestations of those three cases were the same: fever, cough, chest distress, hyoxemia, and

8、 leucopenia. They were given antibiotics and oseltamivir with a good outcome and rehabilitation discharged.ConclusionThe main manifestations of lung on CT in patients with severe H1N1 influenza A are multiple lesions in middle and lower lobes of bilateral lungs with fast development, which character

9、ized mainly as effusion or a little mesenchymal changes. The lesions respond well to anti-inflammatory and antiviral therapy. KEY WORDS influenza A virus, H1N1 subtype; tomography, X-ray computed Influenza A H1N1 influenza global pandemic, broadcast to over 200 countries and regions, the current out

10、break is easing phase of this acute respiratory infectious disease caused by the H1N1 influenza virus, the early symptoms are similar to normal seasonal influenza, mainly fever, cough, sore throat, malaise, headache and fatigue, flu-like symptoms, most of the good prognosis part of the patients cond

11、ition can rapidly progress, ferocious, and a sudden high fever, a temperature over 39 C, and even secondary to severe pneumonia, acute respiratory distress syndrome, pulmonary hemorrhage, pancytopenia, renal failure, sepsis, shock, respiratory failure and multiple organ damage leading to death. hosp

12、ital successfully treated three cases of influenza A （H1N1） cases of severe disease, now the clinical data and literature The report is as follows. 1 clinical data Example 1, female, 11 years old. October 17, 2009 with fever, cough accompanied by chest tightness, body temperature 39.5 C, at home tre

13、atment, symptoms did not improve. October 22 to the fever clinic of a hospital, the measured body temperature of 40.5 C, the date of hospitalization. Chest DR checks showed the left lower lung field coarse texture disorder, middle mediastinum, bilateral rib every angle no abnormal blood: the WBC 2.6

14、 109 / L. previous nine-year history of asthma, epilepsy, a history of seven years in the 10 diagnosed as influenza A （H1N1） cases of severe disease on 23 May to turn our hospital for further treatment. admission examination: generally poor, shortness of breath, tonsil II degree, in, under the lungs

15、 could be heard and dry rales. Chest CT acid is satisfied: in the left lung, lower lobe visible large areas of flocculent exudative shadow of the right lower lobe can be seen a little oozing shadow. Blood gas analysis showed hypoxemia. given furosemide west to each 1.0 g, 2 a day intravenous infusio

16、n; antivirals Austrian Secretary Wei, each of 100 mg twice daily treatment; aerosol inhalation Rupumike, each of 1 mg, 2 times a day; taking antiepileptic drugs .10 26 , Chest CT scan shows lung shadows absorption is not obvious, continue to give the anti-inflammatory and antiviral treatment. again

17、review the chest CT, the lower right lung, left lung mid-and lower lobe effusion shadow of apparent absorption （see Figure 1a, b）. Example 2, female, 13 years old. October 24, 2009 fever, runny nose, sore throat, headache, cough, body temperature up to 39.9 C on October 26th to go to a hospital feve

18、r outpatient chest DR-ray examination no abnormal blood test: WBC 9.3 109 / L, neutrophils 0.892.10 January 27, diagnosed as influenza A （H1N1） critically ill cases to turn the hospital admission examination: pharyngeal hyperemia, bilateral tonsil I large, coarse breath sounds in both lungs. is not

19、known and the wet and dry tone. blood test: WBC 3.2 109 / L and neutrophils 0.788. blood gas analysis showed hypoxemia give ceftriaxone sodium, each 2.0 g, 2 times a day intravenously; Austria Oseltamivir each 100 mg twice daily treatment. October 30 chest CT examination showed: right lower lobe can

20、 be seen scattered in exudative shadow. to continue treatment until November 3rd to review chest CT shows right lung leaves exudative shadows absorption （Figure 2a, b）. Example 3, male, 23 years old, November 20 In 2009, fever, runny nose, cough, body temperature 39.9 . November 23, to a hospital fe

21、ver outpatient chest DR film examination showed: lower left lung markings, bilateral rib every angle sharp, middle mediastinum, initially diagnosed as pneumonia, received hospital treatment. November 24, 2009, the disease progresses rapidly chest tightness, suffocation, significantly worse after the

22、 event. examination: throat congestion, tonsil degree, the lungs could be heard and scattered moist rales. Blood gas analysis showed hypoxemia blood tests showed: WBC count 2.7 109 / L, lymphocytes 0.335, blood biochemical tests showed alanine aminotransferase and aspartate aminotransferase, blood g

23、lucose increased .11 January 25 chest CT showed: bilateral lung in the lower lobe were seen scattered in the flocculent exudate shadow, a double- lower lobe obvious. to continue anti-inflammatory treatment. November 27 review of chest CT: lung lower lobe lesions progress, mainly in interstitial lung

24、 disease. Turn our hospital diagnosed as influenza A （H1N1） critically ill cases. Austrian Secretary to give antiviral drugs oseltamivir treatment, the dose of each 150 mg 2 times a day; to continue anti-inflammatory and symptomatic treatment of .11 on the 30th again to review the chest CT: absorpti

25、on of leaf lesions on the lungs, lung, lower lobe see the shadow of the cord-like absorption is not obvious. December review of chest CT in the 4th: lung lesions absorption （Figure 3a, b）. Figure 1 CT of a patients performance Figure 2 cases of 2 patients with CT findings of Figure 3 cases of 3 pati

26、ents the CT findings Share in the free paper discussion H1N1 influenza virus is a virus family is sticky, influenza virus, it spread between people more vulnerable to infection than seasonal influenza, stronger, children and young adults, but also in many countries around the world continued to spre

27、ad. Mild patients to the community or home isolation and treatment, hospital treatment and home treatment effect differences 1-2, but with complications requiring hospitalization, and longer hospital stay, especially those with lung disease and heart disease, diabetes or patients undergoing immunosu

28、ppressive therapy in our hospital from three cases of Influenza A （H1N1） cases of critically ill patients, clinical manifestations are fever, cough accompanied by chest tightness and early onset of lung X-ray examination were normal, as the disease progresses chest CT scan showed the lung to the low

29、er lobe of the main exudative lesions, extent of disease was sporadic, interstitial changes after the 3 cases of patients admitted to hospital were given antibiotics and antiviral drugs, and symptomatic treatment. Austria Oseltamivir as neuraminidase inhibitors prevents neuraminidase residues divisi

30、on, the interference of influenza virus replication and distribution in the mucosal secretions, reduce the activity of the virus infection during treatment no adverse reactions occur. patients appeared granulocytes during treatment reduced analysis and virus infection and oral oseltamivir treatment

31、related to completion of treatment were normal in stable condition after the review, this neutropenia presents a. Chest CT can provide more lesions than chest DR tablets signs of pulmonary lesions more clearly show the DR-chip interference by many factors 3 and clinical cases of critically ill patie

32、nts in the treatment period, in a timely manner for chest CT check to accurately determine the scope of the lungs, the extent of lung damage, as well as the site of damage, with or without complications, such as chest X-ray film is difficult to show the heart shadow or paraspinal lesions, chest CT can be easily show Therefore, chest CT scan has some advantages