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NEJM：甲型流感病毒感染相关的纵隔气肿-病例报道

2018-01-04 xing.T MedSci原创

甲型流感病毒感染纵隔气肿
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患者接受无创通气支持治疗，并采用扎那米韦治疗流感以及哌拉西林和他唑巴坦扎治疗细菌感染。纵隔气肿未进行额外的干预就得到的缓解，该病人就诊15天后出院。

患者为一名既往健康的33岁的男性，因昏睡和感觉不适10天而到急诊就诊。

该患者的体温是38.3°C，存在心动过速，通过面罩呼吸每分钟15升的氧气，检测到的氧饱和度为85%。体格检查发现左下肺有明显的支气管呼吸音；触诊未触及皮下气肿。

X线胸片显示肺脏双侧肺门影，纵隔内有自由空气（如图A箭头所示）。CT证实为纵隔气肿（如图B箭头所示），存在增强的肺纹理，双肺下叶存在阴影，左侧肺下叶更为严重。咽拭子结果为甲型H1N1流感呈阳性反应。



患者接受无创通气支持治疗，并采用扎那米韦治疗流感以及哌拉西林和他唑巴坦扎治疗细菌感染。纵隔气肿未进行额外的干预就得到的缓解，该病人就诊15天后出院。

原始出处：

Christopher T. Mansbridge, et al. Pneumomediastinum Associated with Influenza A Infection.N Engl J Med 2018. http://www.nejm.org/doi/full/10.1056/NEJMicm1702849

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1975891, encodeId=5a9119e589195, content=<a href='/topic/show?id=06aa69e72da' target=_blank style='color:#2F92EE;'>#甲型流感病毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69772, encryptionId=06aa69e72da, topicName=甲型流感病毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Sat Feb 03 19:45:00 CST 2018, time=2018-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1531213, encodeId=6553153121372, content=<a href='/topic/show?id=244169e70f0' target=_blank style='color:#2F92EE;'>#甲型流感#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69770, encryptionId=244169e70f0, topicName=甲型流感)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=86ba12221972, createdName=redcrab, createdTime=Fri Jan 05 22:45:00 CST 2018, time=2018-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=275729, encodeId=b5132e572961, content=学习学习.继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Fri Jan 05 12:59:00 CST 2018, time=2018-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=275325, encodeId=c3262e532542, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfDEeydJz0GlP8O0ngrUX6AYCXFic0XDOOAyeQicIqnOd4TrWSwiagJrsFNYuWC1Uc6iavbS1hWt9xtZAhAqLGHqZyl/0, createdBy=42891977006, createdName=1e17414fm02(暂无匿称), createdTime=Thu Jan 04 09:25:25 CST 2018, time=2018-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=275319, encodeId=3b012e531905, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Jan 04 08:45:17 CST 2018, time=2018-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=275303, encodeId=abfd2e53034b, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋，懒，贪, createdTime=Thu Jan 04 07:59:21 CST 2018, time=2018-01-04, status=1, ipAttribution=)]
    2018-02-03 shenxlcyp

    #甲型流感病毒#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1975891, encodeId=5a9119e589195, content=<a href='/topic/show?id=06aa69e72da' target=_blank style='color:#2F92EE;'>#甲型流感病毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69772, encryptionId=06aa69e72da, topicName=甲型流感病毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Sat Feb 03 19:45:00 CST 2018, time=2018-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1531213, encodeId=6553153121372, content=<a href='/topic/show?id=244169e70f0' target=_blank style='color:#2F92EE;'>#甲型流感#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69770, encryptionId=244169e70f0, topicName=甲型流感)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=86ba12221972, createdName=redcrab, createdTime=Fri Jan 05 22:45:00 CST 2018, time=2018-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=275729, encodeId=b5132e572961, content=学习学习.继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Fri Jan 05 12:59:00 CST 2018, time=2018-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=275325, encodeId=c3262e532542, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfDEeydJz0GlP8O0ngrUX6AYCXFic0XDOOAyeQicIqnOd4TrWSwiagJrsFNYuWC1Uc6iavbS1hWt9xtZAhAqLGHqZyl/0, createdBy=42891977006, createdName=1e17414fm02(暂无匿称), createdTime=Thu Jan 04 09:25:25 CST 2018, time=2018-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=275319, encodeId=3b012e531905, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Jan 04 08:45:17 CST 2018, time=2018-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=275303, encodeId=abfd2e53034b, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋，懒，贪, createdTime=Thu Jan 04 07:59:21 CST 2018, time=2018-01-04, status=1, ipAttribution=)]
    2018-01-05 redcrab

    #甲型流感#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1975891, encodeId=5a9119e589195, content=<a href='/topic/show?id=06aa69e72da' target=_blank style='color:#2F92EE;'>#甲型流感病毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69772, encryptionId=06aa69e72da, topicName=甲型流感病毒)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Sat Feb 03 19:45:00 CST 2018, time=2018-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1531213, encodeId=6553153121372, content=<a href='/topic/show?id=244169e70f0' target=_blank style='color:#2F92EE;'>#甲型流感#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69770, encryptionId=244169e70f0, topicName=甲型流感)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=86ba12221972, createdName=redcrab, createdTime=Fri Jan 05 22:45:00 CST 2018, time=2018-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=275729, encodeId=b5132e572961, content=学习学习.继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Fri Jan 05 12:59:00 CST 2018, time=2018-01-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=275325, encodeId=c3262e532542, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfDEeydJz0GlP8O0ngrUX6AYCXFic0XDOOAyeQicIqnOd4TrWSwiagJrsFNYuWC1Uc6iavbS1hWt9xtZAhAqLGHqZyl/0, createdBy=42891977006, createdName=1e17414fm02(暂无匿称), createdTime=Thu Jan 04 09:25:25 CST 2018, time=2018-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=275319, encodeId=3b012e531905, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Jan 04 08:45:17 CST 2018, time=2018-01-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=275303, encodeId=abfd2e53034b, content=谢谢分享学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM7GibvIBibibnnnvpajk2stlDF5oichYahI6Bia8uxeTBFoPbdoHWebyXf9eal9FNgUF2lNcrwoZicM3BvQ/0, createdBy=a3742066385, createdName=戒馋，懒，贪, createdTime=Thu Jan 04 07:59:21 CST 2018, time=2018-01-04, status=1, ipAttribution=)]
    2018-01-05 1dd8c52fm63(暂无匿称)

    学习学习.继续关注

    0

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    2018-01-04 1e17414fm02(暂无匿称)

    学习

    0

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    2018-01-04 龙胆草

    学习谢谢分享

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    2018-01-04 戒馋，懒，贪

    谢谢分享学习了

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