人感染H7N9禽流感10例临床分析  

Clinical analysis of 10 cases of human infection with H7N9 avian influenza

作　　者：杨志明[1] 邹天士[1] 赵柏良[2] Yang Zhiming;Zou Tianshi;Zhao Bailiang(Department of Respiratory Medicine,the First People′s Hospital of Zhaoqing City,Zhaoqing 526000,China;Department of Infectious Diseases,the First People′s Hospital of Zhaoqing City,Zhaoqing 526000,China)

机构地区：[1]肇庆市第一人民医院呼吸内科,526000 [2]肇庆市第一人民医院感染疾病科,526000

出　　处：《国际呼吸杂志》2019年第22期1724-1727,共4页International Journal of Respiration

摘　　要：目的分析人感染H7N9禽流感病例的临床特点和影像学特征,为临床早期识别、早期诊治提供参考。方法回归分析肇庆市第一人民医院2014年1月至2018年11月收治的10例人感染H7N9禽流感的临床资料。结果回归分析肇庆市第一人民医院2014年1月至2018年11月收治的10例人感染H7N9禽流感患者中男6例,女4例,年龄5~76岁,中位年龄为47.5岁。儿童2例,且均为轻症。65岁以上1例。9例有家禽接触史,1例无明确家禽接触史。临床以发热、咳嗽为特点,伴呼吸困难,大部分病例短期内发展为重症肺炎。白细胞计数正常的有4例,下降的有6例。X线胸片或胸部CT影像学示肺部以实变影为主,病灶周围可见磨玻璃影。发病到服用奥司他韦的平均时间是5.5 d。重症肺炎7例,有7例接受有创呼吸机辅助通气,有1例接受无创呼吸机辅助通气。2例应用连续性肾脏替代治疗,甲泼尼龙治疗的有5例,接受乌司他丁治疗的有1例。死亡6例,治愈4例。结论儿童病例以轻症为主,成人病例多短期内进展为重症肺炎,表现为呼吸困难,肺部渗出明显,病死率极高;应及早诊断、早期治疗,以降低病死率。Objective To analyze the clinical features and imaging features of patients with H7N9 avian influenza infection,in order to provide reference for early clinical identification,diagnosis and treatment.Methods The clinical data of ten cases collected in the First People′s Hospital of Zhaoqing City from January 2014 to November 2018,of human infection with H7N9 avian influenza were analyzed.Results The ten patients with confirmed included six males and four females,aged from 5 to 76 years old,with a median age of 47.5 years.There were two cases in children,all of which were mild.Nine patents had a history of to the poultry trading places,or direct contact with ill/dead avian,while one case had no history contact with poultry.The most common initial symptoms were fever,cough,and respiratory distress.Most cases progressed rapidly to severe pneumonia.White blood cell counts were normal in four cases and decreased in six cases.Chest radiography or chest CT imaging showed that the lung was dominated by consolidation and vitreous shadows were seen around the lesion.The average time of onset to Oseltamivir treatment were 5.5 days.There were seven patients with severe pneumonia,seven patients received invasive ventilator assisted ventilation and one patient received non-invasive ventilator assisted ventilation.Continuous renal replacement therapy was used to clear inflammatory mediators in two cases.There were five cases treated with methylprednisolone.There was one case with ulinastatin treatment.Four patients were discharged,and six cases died.Conclusions Most of the cases in children are mild,and most of the cases in adults developed into severe pneumonia within a short period of time,showing dyspnea,obvious pulmonary exudation and extremely high mortality.Early diagnosis and treatment should be given to reduce mortality.

关 键 词：禽流感 肺炎 H7N9亚型 

分 类 号：S85[农业科学—兽医学]