| Objective: To analyze and discuss the imaging changes and clinicalfeatures of the confirmed cases of new type influenza A (H1N1), and toimprove the diagnose ability of pneumonia caused by new type influenzaA(H1N1).Methods:480confirmed cases of new type influenza A(H1N1)in HebeiProvince, including267ordinary cases(55.6%),108severe cases(22.5%) and105critical cases(21.9%), were involved in this study. The clinicalmenifestations combining the general condition including age, sex, underlyingdiseases, temperature, heart rate, respiratory rate etc, the index detected byarterial blood gas indexes etc, the therapeutic conditions including medicinesand respiratory support etc, in addition, the thoracic imaging data of all thesecase were analyzed. The results of chest X ray and thoracic CT examination,were comparatively analyzed.Results: Among the480confirmed cases,192cases were male,288cases were female, the age was between3and78years old with the average of（35±19）years old,188cases were pregnant(47.92%) for（30.31±7.85）weeks, and175cases (36.5%) were suffered underlying diseases. The clinicalmanifestations were fever(94.5%), cough(94.5%), expectoration(71.5%),pharyngalgia(54.4%), dyspnea(42.9%) and lung roles(65.0%). The symptomsand signs of the severe and critical patients were severe, while dyspnea,cyanosis, hemoptysis, chest pain, and even the symptoms of neural system anddisturbance of consciousness were commonly observed in critical patients.And with the progression of the disease, the acute physiology and chronichealth evaluation (APACHE II） and sepsis-related organ failure assessment(SOFA）elevated with a significant difference among these3group（sP<0.05）.The laboratory examination suggested that the deterioration of the disease resulted in the decreasing of albumin, percentage of lymphocytes andoxygenation index, and the increasing of percentage of neutralphils(P<0.05).Mild symptoms and higher frequency of normal thoracic images could beobserved in267cases of ordinary patients compared with the severe andcritical group(P<0.001,PearsonX2test). Among the267cases of ordinarypatients, normal or no significant thoracic imaging signs were found in213cases(80%of the ordinary patients), Pulmonary interstitial changes, whichwere simple ground-glass opacity or with ground-glass opacity as the mainchanges, reticular lesions(inhomogeneous density,irregular margin and lungmarkings) were found in early chest X ray in54cases. Fever, cough,expectoration and lung rale were found in severe and critical patient whileserious dyspnea and a rapidly progressive course were observed in criticalgroup. The lung lesion mainly located in lower lobes with the characteristicsof ground-glass opacity and pulmonary consolidation. Among108severecases, focal consolidation presented as mottling shadows with high densitywas found in40cases, interstitial infiltration was found in68cases.Pneumonic foci, of which the main manifestations were consolidation, limitedor diffuse spotty shadow, accompanied with pleural effusion, hydronpe-umothorax and atelectasis etc, were found in all the105critical cases. Besidesantivirus therapy (Oseltamivir), other adjuvant therapy including anti-infectionwith antibiotics, anti-inflammation with glucocorticoid, oxygen therapy,immunoregulation and mechanical ventilation were applied. Among the casestreated by mechanical ventilation, higher rate of abnormal thoracic imagingfindings and lesions in more than3lobes was found when compared withcases not treated by mechanical ventilation, while there was no significantdifference between the cases treated by invasive and noninvasive mechanicalventilation. The applying of invasive mechanical ventilation was easilycomplicated with infection of bacteria and fungi, and longer ventilation time,administrating days and higher mortality rate were found when compared withnoninvasive mechanical ventilation group with significant difference(P<0.05).Under comprehensive treatment for7~14d,14~21d or>21d after onset of the disease, which were3main time quanta compared with others (P<0.001),residual lung fibrosis was found in124cases, and the ordinary and severecases were all improved or cured.61cases were dead, occupying58.1%(61/105) of the critical cases.Conclusion:1. The main clinical manifestations of H1N1viral influenza arepyrexia, cough, and expectoration. But high risk group can develop into severeand critical case with dyspnea and hyoxemia. Wide lung lesion is present; withpatient’s condition aggravating, the proportion of neutrophils in patient’s bodywill increase, while the seralbumin level, lymphocyte ratio, and oxygenationindex will decrease. Based on antiviral treatment, mechanical ventilationsupporting therapy is the chief supplementary mean. However, higherinfection rate of invasive mechanical ventilation and fungus, ARDS, MODSand infectious shock are the primary causes of death of critical cases.2. The image manifestation of H1N1viral pneumonia is mainly composed ofconsolidation opacity which involved both lungs and developed from lungedge to the center. Air bronchogram is present; pleura could be involved.Common distribution locates in middle and lower lung,1/3middle and outerlung field, and underneath of pleura. Lung imageological inspection cancontribute to reflecting order of severity and development and change of thelesion. The primal lung image inspections of mechanical ventilation all showabnormal results and the prime lung lesion covers more than3lung lobes,implying that early condition of critical patient is severe and lung lesionmakes speedy progress. Most chest manifestations of ordinary patient arenormal. The imageology of severe and critical patients is basically based onacute pneumonia and acute interstitial pneumonia. Interstitial change, majorexudation focus could emerge for severe patients. Lung marking presentsground glass opacity or high-density patch opacity. Extensive intra-lungexudation is present in severe case, showing consolidation opacity of largearea. Lesion progress is rapid, patient’s condition is severe, residual fibrosis ispresent in lung. |
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