1例发热就诊甲型流感并发重症肺炎诊治分析  

Diagnosis and treatment of 1 case of fever and influenza A patient complicated with severe pneumonia

作　　者：赵春洪[1] 肖红菊[1] 陈歆[1] 翟永志[1] 刘昕[1] 刘刚[1] 黎檀实[1] ZHAO Chun-hong;XIAO Hong-ju;CHEN Xin;ZHAI Yong-zhi;LIU Xin;LIU Gang;LI Tan-shi(The First Medical Center of Chinese PLA Genera/Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第一医学中心急诊科,北京100039

出　　处：《中华医院感染学杂志》2021年第1期78-81,共4页Chinese Journal of Nosocomiology

基　　金：解放军总医院科技创新苗圃基金资助项目(17KMM50);解放军总医院大数据研发项目(2017MBD-30)。

摘　　要：目的分析1例甲型流感病毒感染合并重症肺炎患者的临床特点,提高对该病的认识及诊治水平。方法对解放军总医院第一医学中心诊治的1例以持续发热就诊的甲型流感病毒感染合并重症肺炎患者的临床资料进行回顾性分析,总结诊治经验。结果患者为女性,47岁,主因"发热20余天"来诊,伴咳嗽、气促、喘憋、呼吸困难,动脉血气提示Ⅰ型呼吸衰竭,入院时外周静脉血白细胞计数正常、中性粒细胞百分比升高、淋巴细胞百分比降低,血生化以乳酸脱氢酶升高、白蛋白降低为特点,甲型流感病毒核酸阳性,肺CT提示双肺弥漫性磨玻璃病变,诊断为甲型流感病毒感染合并重症肺炎、Ⅰ型呼吸衰竭,予磷酸奥司他韦抗病毒,先后予"头孢哌酮舒巴坦、左氧氟沙星、头孢呋辛"抗感染,"氟康唑"预防真菌感染,甲强龙抗炎及无创呼吸机辅助通气等治疗后好转出院。结论长期发热患者伴肺部病变尤其肺CT示磨玻璃样病变,仍应高度警惕甲型流感病毒感染可能,流感病毒合并重症肺炎患者病情危重病死率高,早期确诊及尽早抗病毒等治疗对挽救患者生命、改善预后具有重要价值。OBJECTIVE To investigate the clinical characteristics of the patient complicated with influenza A virus infection and severe pneumonia so as to boost the understanding of the disease and improve the diagnosis and treatment.METHODS The clinical data of 1 case of chronic fever patient complicated with influenza A virus infection and severe pneumonia who was treated in the First Medical Center of Chinese PLA General Hospital were retrospectively analyzed,and the diagnosis and treatment experience was summarized.RESULTS The case was a female patient,47 years old,with more than 20 days of fever as the chief complaint,complicated with cough,shortness of breath,breath holding,breathing difficulties,arterial blood gas hint 1 type of respiratory failure.At the admission to the hospital,the case was characterized by normal peripheral venous blood WBC counts,rise of neutrophils percentage,decline of lymphocyte percentage,rise of lactic dehydrogenase and decline of albumin,with nucleic acid of influenza A virus tested positive,the chest CT prompted double lung lesions diffuse ground glass,the case was diagnosed with influenza A virus infection complicated with severe pneumonia and type I respiratory failure and was given oseltamivir phosphate for antiviral treatment and then cefoperazone-sulbactam,levofloxacin,cefuroxime for anti-infection treatment,fluconazole for prevention of fungal infection,methylprednisolone for anti-inflammatory treatment,non-invasive ventilator for assisted ventilation,the illness condition was improved,and the case was discharged.CONCLUSION The chest CT of the chronic fever patients complicated with pulmonary lesions shows ground-glass-like lesions,the mortality rate of the influenza A virus infection patient complicated with severe pneumonia is high,and it is necessary to remain vigilant to the possibility of influenza A virus infection and conduct the early diagnosis and antiviral treatment so as to save the life and improve the prognosis.

关 键 词：发热 甲型流感病毒 重症肺炎 诊断 治疗 

分 类 号：R563[医药卫生—呼吸系统]