流行性感冒影像表现及最新国家诊疗方案要点
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摘要
近100年历史上发生过六次流感大暴发流行,西班牙流感是历史上最可怕的十大流行性传染病之一,造成数以万计的患者死亡。为此,中国在2009、2011、2018版流感诊疗方案的基础上制订了2018流感诊疗方案修订版。在一年内正式出台了两个诊疗方案,足见国家卫健委对中国流感的防诊治高度重视,并且以科学的态度对方案进行修订发布。该方案对流感的病原学、流行病学、确诊依据、治疗原则及治疗方法等进行了阐述,使其更准确地指导中国流感的有效防控,具有可操作性和实用性。流感并发肺炎尤其是重症及危重症患者临床诊断和治疗较为困难,CT检查和诊断在流感肺炎的诊断、疗效评价等方面具有一定价值。流感并发肺炎具有以下特点:(1)磨玻璃密度影和肺实变密度影;(2)累及多肺叶肺段,两肺下野较重;(3)伴有胸腔积液和/或心包积液;(4)儿童流感肺炎还应注意并发流感相关脑病和急性坏死性脑炎等。影像学特点和影像学分类分型可为临床诊断、治疗和疗效评价提供重要参考。
In the past 100 years, there have been six outbreaks and epidemics of influenza. Sibamia flu is one of the ten most terrible infectious diseases in history, causing tens of thousands of patients to die. To this end, China has developed a revised version of the 2018 Influenza diagnosis and treatment Plan based on the 2009/2011/2018 Influenza Diagnostic Plan. Within one year, two diagnosis and treatment plans were formally introduced, which shows that the National Health and Health Commission attaches great importance to the prevention and treatment of influenza in China, and has revised and released the plan in a scientific manner. The etiology, epidemiology, diagnosis basis, treatment principles and treatment methods of influenza are described in this paper. To guide the effective prevention and control of influenza in China accurately, it has feasibility and practicability. The clinical diagnosis and treatment of influenza pneumonia, especially the severe and critical cases, are difficult. CT examination and diagnosis are valuable in the diagnosis and evaluation of the curative effect of influenza pneumonia. Influenza pneumonia had some characteristics, such as:(1) glass opacity and pulmonary density shadow,(2) multiple lobar lung segments, severe lower lung fields,(3) pleural effusion and/or pericardial effusion, and pericardial effusion. Children with influenza pneumonia should also pay attention to influenza associated encephalopathy and acute necrotizing encephalitis. Imaging features and imaging classification can be helpful for clinical diagnosis, treatment and evaluation of curative Useful help.
In the past 100 years, there have been six outbreaks and epidemics of influenza. Sibamia flu is one of the ten most terrible infectious diseases in history, causing tens of thousands of patients to die. To this end, China has developed a revised version of the 2018 Influenza diagnosis and treatment Plan based on the 2009/2011/2018 Influenza Diagnostic Plan. Within one year, two diagnosis and treatment plans were formally introduced, which shows that the National Health and Health Commission attaches great importance to the prevention and treatment of influenza in China, and has revised and released the plan in a scientific manner. The etiology, epidemiology, diagnosis basis, treatment principles and treatment methods of influenza are described in this paper. To guide the effective prevention and control of influenza in China accurately, it has feasibility and practicability. The clinical diagnosis and treatment of influenza pneumonia, especially the severe and critical cases, are difficult. CT examination and diagnosis are valuable in the diagnosis and evaluation of the curative effect of influenza pneumonia. Influenza pneumonia had some characteristics, such as:(1) glass opacity and pulmonary density shadow,(2) multiple lobar lung segments, severe lower lung fields,(3) pleural effusion and/or pericardial effusion, and pericardial effusion. Children with influenza pneumonia should also pay attention to influenza associated encephalopathy and acute necrotizing encephalitis. Imaging features and imaging classification can be helpful for clinical diagnosis, treatment and evaluation of curative Useful help.
引文
[1]中华人民共和国国家卫生和计划生育委员会.流行性感冒诊疗方案(2018年修订版)[EB/OL].[2018-11-20].http://www.nhc.gov.cn/yzygj/s7653/201811/ddcb7962b5bc40fa8021009b8f72e8a7.shtml.
[2]梁德雄,蒙光国,罗文峰,等.31例重症和危重症甲型H1N1流感患者的临床与影像学表现特点[J].放射学实践,2010,25(9):961-964.
[3]朱文科,刘映霞,陆普选,等.孕产妇甲型H1N1流感肺炎的临床及影像学特点[J].放射学实践,2010,25(9):982-985.
[4]邓莹莹,陆普选,刘映霞,等.甲型H1N1流感肺炎的胸部CT表现及动态变化特点[J].中国医学影像技术,2010,26(6):1108-1111.
[5]杨根东,陆普选,曹义,等.甲型H1N1流感肺炎的CT表现与分型[J].广东医学,2010,31(21):2822-2823.
[6]陆普选,邓莹莹,杨桂林,等.新型甲型H1N1流感患者体内病毒载量与胸部CT表现的关系[J].中华结核与呼吸杂志,2010,30(10):746-749.
[7]Lu PX,Wang YX,Zhou BP,et al.Radiological features of lung changes caused by avian influenza subtype A H5N1virus:report of two severe adult cases with regular follow-up[J].Chin Med J,2010,123(1):100-104.
[8]邓莹莹,陆普选,杨桂林,等.甲型H1N1流感肺炎胸部CT表现半定量评分与病毒载量的相关性研究[J].放射学实践,2010,25(9):965-967.
[9]苏伟,张复春.甲型流感研究进展[J].新发传染病电子杂志,2018,3(3):182-187.
[10]马世良,刘珺伊,施泽纶,等.甲型H1N1流感的诊治与预防[J].新发传染病电子杂志,2018,3(3):137-139.
[11]曾洪武,黄文献,干芸根,等.儿童危重症甲型H1N1流感中枢神经系统并发症的影像学表现[J].放射学实践,2010,25(9):947-950.
[2]梁德雄,蒙光国,罗文峰,等.31例重症和危重症甲型H1N1流感患者的临床与影像学表现特点[J].放射学实践,2010,25(9):961-964.
[3]朱文科,刘映霞,陆普选,等.孕产妇甲型H1N1流感肺炎的临床及影像学特点[J].放射学实践,2010,25(9):982-985.
[4]邓莹莹,陆普选,刘映霞,等.甲型H1N1流感肺炎的胸部CT表现及动态变化特点[J].中国医学影像技术,2010,26(6):1108-1111.
[5]杨根东,陆普选,曹义,等.甲型H1N1流感肺炎的CT表现与分型[J].广东医学,2010,31(21):2822-2823.
[6]陆普选,邓莹莹,杨桂林,等.新型甲型H1N1流感患者体内病毒载量与胸部CT表现的关系[J].中华结核与呼吸杂志,2010,30(10):746-749.
[7]Lu PX,Wang YX,Zhou BP,et al.Radiological features of lung changes caused by avian influenza subtype A H5N1virus:report of two severe adult cases with regular follow-up[J].Chin Med J,2010,123(1):100-104.
[8]邓莹莹,陆普选,杨桂林,等.甲型H1N1流感肺炎胸部CT表现半定量评分与病毒载量的相关性研究[J].放射学实践,2010,25(9):965-967.
[9]苏伟,张复春.甲型流感研究进展[J].新发传染病电子杂志,2018,3(3):182-187.
[10]马世良,刘珺伊,施泽纶,等.甲型H1N1流感的诊治与预防[J].新发传染病电子杂志,2018,3(3):137-139.
[11]曾洪武,黄文献,干芸根,等.儿童危重症甲型H1N1流感中枢神经系统并发症的影像学表现[J].放射学实践,2010,25(9):947-950.