肺部超声在甲型H7N9流感重症肺炎中的应用

doi:10.3877/cma.j.issn.1672-6448.2019.01.016

图1 患者，男性，63岁，经病毒核酸检测确诊为H7N9禽流感重症肺炎，其不同病程阶段的肺部超声及胸部放射影像学表现。图a~c为入院时患者肺部超声及胸部X线片表现。图a为肺部超声示双肺5、6区多个肋间可见密集B线回声；图b为肺部超声示双肺1~4区多个肋间可见稀疏B线回声，胸膜线不光滑。双侧胸膜下少量液性暗区（箭头所示）；图c为胸部X线片示双肺渗出性改变并胸腔积液，以左侧为著。图d~f为治疗1周后患者肺部超声及胸部X线片表现。图d为肺部超声示双肺1~3区多个肋间可见稀疏B线回声，胸膜线不光滑；图e为肺部超声示左肺6区可见范围1.9 cm×4.6 cm实变的肺组织（箭头所示）；图f为胸部X线片示双肺渗出稍有吸收，左下肺叶萎缩未见明显变化，左侧胸腔积液减少。图g~i为出院时患者肺部超声及胸部CT表现。图g为肺部超声示双肺1~4区可见A线，未见B线；图h为肺部超声示左肺6区可见范围1.0 cm×2.6 cm实变的肺组织（箭头所示）及稀疏B线回声；图i为胸部CT示双下肺炎症较前有所吸收，双侧胸膜腔积液已吸收，左肺下叶肺实变

图2 患者，女性，52岁，经病毒核酸检测确诊为H7N9禽流感重症肺炎，其不同病程阶段的肺部超声及胸部放射影像学表现。图a~c为入院时患者肺部超声及胸部X线片表现。图a为肺部超声示双肺3~6区多个肋间可见密集B线回声；图b为肺部超声示右肺5区实变的肺组织（箭头所示）；图c为胸片X线示双肺渗出性改变并胸腔积液，以左侧为著。图d~f为治疗5天后患者肺部超声及胸部X线片表现。图d为肺部超声示双肺5、6区多个肋间可见密集B线；图e为肺部超声示右肺5区实变的肺组织（箭头所示）；图f为胸部X线片示双肺渗出稍有吸收，左下肺叶萎缩未见明显变化，左侧胸腔积液减少。图g~i为出院时患者肺部超声及胸部CT表现。图g为肺部超声示双肺多个肋间可见稀疏B线回声；图h为肺部超声示右肺5区实变的肺组织较前缩小（箭头所示）；图i为胸部CT示双下肺炎症较前有所吸收，双侧胸膜腔积液已吸收，左肺下叶肺实变

图3 患者，男性，76岁，经病毒核酸检测确诊为H7N9禽流感重症肺炎，其不同病程阶段的肺部超声及胸部放射影像学表现。图a~c为入院时患者肺部超声及胸部X线片表现。图a为肺部超声示双肺多个肋间可见如图密集B线，胸膜线不光滑；图b为肺部超声示左肺5、6区之间见实变的肺组织（箭头所示）；图c为胸部X线片示双肺渗出性改变并胸腔积液，以左侧为著。图d~f为治疗6 d后患者肺部超声及胸部X线片表现。图d为肺部超声示双肺多个肋间可见稀疏B线；图e为肺部超声示左肺5、6区之间见实变的肺组织（箭头所示）；图f为胸部X线片示双肺渗出稍有吸收，左下肺叶萎缩未见明显变化，左侧胸腔积液减少。图g~i为出院时患者肺部超声及胸部CT表现。图g为肺部超声示双肺1~6区2~3个肋间可见稀疏B线；图h为肺部超声示左肺5、6区之间见实变的肺组织较前缩小（箭头所示）；图i为胸部CT示双下肺炎症较前有所吸收，双侧胸膜腔积液已吸收，左肺下叶肺实变

1	Wang X, Jiang H, Wu P, et al. Epidemiology of avian influenza A H7N9 virus in human beings across five epidemics in mainland China, 2013-17: an epidemiological study of laboratory-confirmed case series [J]. Lancet Infect Dis, 2017, 17(8): 822-832.
2	Yin W, Li Y, Zeng X, et al. The utilization of critical care ultrasound to assess hemodynamics and lung pathology on ICU admission and the potential for predicting outcome [J]. PLoS One, 2017, 12(8): e0182881.
3	Leech M, Bissett B, Kot M, et al. Lung ultrasound for critical care physiotherapists: a narrative review [J]. Physiother Res Int, 2015, 20(2): 69-76.
4	Lichtenstein D, Mezière G. The BLUE-points: three standardized points used in the BLUE-protocol for ultrasound assessment of the lung in acute respiratory failure [J]. Crit Ultrasound J, 2011, 3: 109-110.
5	Wang G, Ji X, Xu Y, et al. Lung ultrasound: a promising tool to monitor ventilator-associated pneumonia in critically ill patients [J]. Crit Care, 2016, 20(1): 320.
6	Xirouchaki N, Kondili E, Prinianakis G, et al. Impact of lung ultrasound on clinical decision making in critically ill patients [J]. Intensive Care Med, 2014, 40(1): 57-65.
7	李虹, 李一丹, 朱维维, 等. 高频胸膜肺超声对呼吸困难患者肺部疾病的诊断价值: 与CT对照研究 [J]. 中华超声影像学杂志, 2016(4): 305-308.
8	Lichtenstein DA. Lung ultrasound in the critically ill [J]. Ann Intensive Care, 2014, 4(1): 1.
9	Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill [J]. Chest, 2015, 147(6): 1659-1670.
10	朱维维, 李一丹, 李虹, 等. 间质性肺疾病肺超声表现与心脏受累程度之间的相关性研究 [J]. 中华超声影像学杂志, 2016, 25(9): 743-749.
11	Lichtenstein DA, Lascols N, Meziere G, et al. Ultrasound diagnosis of alveolar consolidation in the critically ill [J]. Intensive Care Med, 2004, 30(2): 276-281.
12	Inglis AJ, Nalos M, Sue KH, et al. Bedside lung ultrasound, mobile radiography and physical examination: a comparative analysis of diagnostic tools in the critically ill [J]. Crit Care Resusc, 2016, 18(2): 124.
13	Soldati G, Sher S. Bedside lung ultrasound in critical care practice [J]. Minerva Anestesiol 2009, 75(9): 509-517.

No related articles found!

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Application of pulmonary ultrasound in severe pneumonia caused by influenza A H7N9 infection

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Application of pulmonary ultrasound in severe pneumonia caused by influenza A H7N9 infection