危重型乙型流感病毒肺炎5例诊治并文献复习  

Diagnosis and treatment of five cases of severe influenza B virus pneumonia and literature review

作　　者：黄燕[1] 刘一[1] HUANG Yan;LIU Yi(Department of Respiratory and Critical Medical,Air Force Medical Center,Beijing 100142,China)

机构地区：[1]空军特色医学中心(原空军总医院)呼吸与危重症医学科,北京100142

出　　处：《空军医学杂志》2019年第2期160-163,共4页Medical Journal of Air Force

摘　　要：目的探讨危重型乙型流感病毒肺炎的临床特点及诊治。方法收集2017年11月—2018年4月空军特色医学中心(原空军总医院)呼吸与危重症医学科收治的5例危重型乙型流感肺炎患者的临床表现、影像学特点及诊治经过,并结合文献进行分析。结果 5例危重乙型流感病毒肺炎,3例既往无基础疾病,1例为结肠癌术后2年,1例为确诊为过敏性紫癜6个月;5例均表现为发热,咳嗽及胸闷,3例有肌肉酸痛;5例患者血气分析均提示Ⅰ型呼吸衰竭,其中2例予经鼻高流量湿化氧疗,另3例需无创正压通气维持氧合;5例患者肺部影像学表现为两肺多发的磨玻璃影及斑片影;5例患者均给予奥司他韦,抗生素预防继发感染,并给予短程甲泼尼龙及丙种球蛋白治疗;4例患者好转出院,1例继发细菌感染死亡。结论成人危重型乙型流感病毒肺炎总体预后较好,合并基础疾病及继发感染是预后不佳的危险因素。Objective To investigate the clinical characteristics,diagnosis and treatment of severe influenza B virus pneumonia.Methods Data on clinical manifestations,imaging features and therapeutic effects of five cases of severe patients with influenza B pneumonia admitted between November 2017 and April 2018 was collected and analyzed in combination with literature.Results Among the five cases,three were females and two were males aged 43 to 72.Three of the cases used to have no diseases,one was a patient of postoperative colon cancer for 2 years,and the other one was diagnosed with allergic purpura six months.Clinical manifestations of the five cases were fever,cough and chest tightness.Three of the cases had muscle soreness.Arterial blood gas analysis showed respiratory failure type 1 in each of these cases,two of whom were treated with high-flow nasal cannula oxygenation and the rest with noninvasive positive pressure ventilation to maintain oxygenation.Lung imaging of the five cases showed multiple ground glass opacity and patchy shadows in both sides of the lung.All these five casess were treated with oseltamivir for influenza B virus,and antibiotics were used to prevent secondary infections.All the five cases were treated with methylprednisolone and gamma globulin in short terms.Four of the cases were improved and were discharged,but one case died of secondary infections.Conclusion The overall prognosis of severe influenza B pneumonia in adults is better.Complications with underlying diseases and secondary infections are a risk factor for poor prognosis.

关 键 词：乙型流感病毒 病毒性肺炎 呼吸衰竭 文献复习 

分 类 号：R563.1[医药卫生—呼吸系统]