11例以重症肺炎为首发表现的人感染H7N9禽流感临床分析.doc
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1、11例以重症肺炎为首发表现的人感染H7N9禽流感临床分析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, Huzh
2、ou 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 rad
3、iological 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, a
4、nd 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, post
5、erior 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. Conclusi
6、on Severe pneumonia and respiratory failure are commonly observed in human infection of H7N9 bird flu. Early administration of oseltamivir for anti-virus therapy can effectively relieve the symptoms and prevent severe complications. To improve the recognition of clinical and radiological features of
7、 human infection of H7N9 bird flu can facilitate the diagnosis and prognosis of such disease. Key words Influenza virus A; H7N9 subtype; Bird flu; Severe pneumonia; Clinical features; Oseltamivir H7N9禽流感病毒是正黏病毒科甲型流感病毒属中可感染人的禽流感病毒亚型之一。自2013年春季我国首次向世界卫生组织(WHO)通报H7N9病例以来1,我国长三角地区,近年来人感染H7N9禽流感疫情呈散发趋势。患
8、者起病较轻,短时间内多迅速进展为急性呼吸窘迫综合征,死亡率达20%。浙江省湖州市中心医院为市级定点医院,2013年4月1日2014年10月30日浙江省湖州地区确诊11例人感染H7N9禽流感病例,现报道如下。 1 资料与方法 1.1 一般资料 选择2013年4月1日2014年10月30日湖州市确诊为人感染H7N9禽流感的患者共11例,其中男5例,女6例;年龄3281岁,中位年龄56岁。11例患者中有2例无基础疾病,9例有基础疾病,其中高血压3例,糖尿病1例,高血压、糖尿病1例,胃溃疡2例,冠心病1例,淋巴瘤1例。诊断标准:入选患者诊断均符合卫生部人感染H7N9禽流感诊疗方案2013年第2版标准2
9、:有发热,流感样症状或肺炎表现,咽拭子人感染H7N9禽流感病毒核酸阳性;采用反转录聚合酶链反应(RT-PCR)方法,由省疾控中心复查人感染H7N9禽流感核酸阳性。 1.2方法 采用综合治疗方法对患者进行治疗:抗病毒:口服或鼻饲奥司他韦胶囊,重症150 mg,2次/d;抗炎:4例;抗炎症介质:乌司他丁,10万U,静脉泵注,3次/d;抗休克、提高免疫:白蛋白、丙种球蛋白支持治疗,白蛋白1020 g,静脉滴注,2次/d;丙种球蛋白10g,静脉滴注,1次/d;化痰:痰热清、沐舒坦等化痰治疗;调节微生态:米雅片,2片/次,3次/d,口服;激素:甲基强的松龙40 mg/d,危重者120 mg/d,静脉泵注
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- 11 重症 肺炎 首发 表现 感染 H7N9 禽流感 临床 分析
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