天津医药

• 甲型H1N1流感专题 •    

重症甲型H1N1流感病毒肺炎的临床和病理特征

李冠华   

  1. 天津市胸科医院
  • 收稿日期:2009-12-21 修回日期:2010-01-06 出版日期:2010-01-15 发布日期:2010-01-15
  • 通讯作者: 李冠华

Clinical and Pathological Features of Severe Influenza A H1N1 Influenza Virus Pneumonia（Report of 24 Cases）

  • Received:2009-12-21 Revised:2010-01-06 Published:2010-01-15 Online:2010-01-15

PDF (PC)

2573

摘要： 摘要 目的：探讨危重症甲型H1N1流感病毒肺炎患者的主要临床特点，气道内分泌物及肺、心脏病理学改变与持续性低氧血症的关系。方法：回顾性分析入住RICU中的危、重症甲流肺炎患者的临床资料。结果：24例患者平均年龄48.25±19.73岁，孕产妇、肥胖及有慢性基础病者15例。进行性气短、咳嗽、肌肉酸痛是主要症状。双肺多发实变影占91.67%。入院后5例气道内分泌物中蛋白质为34.1g/L-37.7 g/L,LDH为792U/L-1890U/L。白细胞计数为722/ml-1470/ml，中性粒细胞分类为21-44%,单核细胞为11.1-56%，嗜酸粒细胞为2.7-11%，嗜碱粒细胞为1.8-5.4%。病理学变化：肺透明膜形成，肺泡腔塌陷；心肌细胞变性、心肌灶性坏死。气管插管机械通气支持治疗6例，死亡5例，死亡率20.83%。结论：有基础疾病及孕产妇、发病后未及时应用有效的抗甲流病毒药物者是发展为危、重症的重要因素；气道内分泌物LDH、蛋白质升高、炎性细胞增多是肺部病理损害的表现；机械通气支持对于部分肺内广泛实变者效果不理想，且相关的并发症是部分患者病情加重或死亡的促发因素。

关键词: 病毒性肺炎, 气道分泌物, 细胞学, 病理学, 机械通气

Abstract: Clinical and Pathological Features of Severe Influenza A H1N1 Influenza Virus Pneumonia（Report of 24 Cases） Liguanhua Zhangli Liyuechuan Jiawei Zhangdongrui Gaoshulian Zhaoyong Abstract Object：To research the main clinical features of critically ill patients with influenza A H1N1 influenza virus pneumonia, try to find the relationship between airway secretions and cardiopulmonary pathology change with continuous hypoxemia. Methods: It was a retrospective analysis of the critically ill patients with influenza A H1N1 influenza virus pneumonia admitted in RICU. Result: Average age of 24 patients was 48.25±19.73 years old. 15 of them were pregnant women, obesity and who suffered chronic underlying diseases. The main symptoms of them were progressive shortness of breath, cough and myalgia. 91.67% patients had found multiple lung consolidation shadow by X-ray. After admission, airway secretions were collected, and the protein concentration of which was 34.1g/L-37.7g/L in 5 cases. Their LDH concentration was 792U/L- 1890U/L. White blood cell count was 722/ml-1470/ml, included 21-44% neutrophils, 11.1-56% mononuclear cells, 2.7-11% eosinophils, 1.8-5.4% basophils. Pathological changes of these patients were hyaline membrane formation, alveolar cavity collapse, myocardial cell degeneration and focal myocardial necrosis. Intubation and mechanical ventilation in 6 cases, 5 of them dead and the mortality rate was 20.83%. Conclusion: Those patients who suffered underlying diseases, maternal and who hadn’t been subject to effective and timely application of antiviral drugs after onset. LDH and protein in airway secretions increased, count of inflammatory cells increased was the performance of lung pathological damage. Effect of Mechanical ventilation was not satisfied in part of patients who had diffuse lung consolidation in X-ray, and the related complications leaded to exacerbation or death in part of them.

Key words: Viral pneumonia, Airway secretions, Cytology, Pathology, Mechanical ventilation.