中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2009年
5期
351-355
,共5页
罗宏%范梦柏%曹彬%钱素云%宋承平%赵爱斌%刘克战%张卓彦%王朝海%郝国平%毕惠君
囉宏%範夢柏%曹彬%錢素雲%宋承平%趙愛斌%劉剋戰%張卓彥%王朝海%郝國平%畢惠君
라굉%범몽백%조빈%전소운%송승평%조애빈%류극전%장탁언%왕조해%학국평%필혜군
禽流感%呼吸窘迫综合征'成人%糖皮质激素类%免疫血浆
禽流感%呼吸窘迫綜閤徵'成人%糖皮質激素類%免疫血漿
금류감%호흡군박종합정'성인%당피질격소류%면역혈장
Influenra in birds%Respiratory distress syndrome,adult%Glucocorticoida%Vaccinated plasma
目的 探索高致病性禽流感A/H5N1病毒感染(简称人禽流感)病例的临床特点及治疗体会.方法 对2009年1月17口山西省太原市第四人民医院收治的1例人禽流感患者的临床表现、实验室检查、影像学改变及治疗方法等进行总结.结果 患者鼻咽抽取物A/H5N1病毒经逆转录聚合酶链反应(RT-PCR)、实时PCR榆测A/H5N1病毒核酸阳性,确诊为人禽流感病例.患儿女,2岁11个月,体重11 kg.患儿平素体健,发病的有活禽屠宰市场环境暴露史.以发热、咳嗽、呼吸困难为主要症状;肺部病灶进展快,病程第8天肺部病变迅速进展,x线胸片呈"白肺",病情迅速进展为ARDS,静脉应用甲泼尼龙165 mg(15 mg·kg-1·d-1)及无创通气治疗,病程第9天病情有所好转,肺部病灶明显吸收;病程第11天开始给予奥司他韦及100 ml高滴度A/H5N1病毒疫苗免疫血浆,后患者病情日见好转,氧合指数及各种酶学指标恢复正常,肺内病灶明显吸收;病程第28大患者好转出院.结论 人禽流感发现晚、病情重、进展快,临床主要表现为严重的ARDS;有效的氧疗及呼吸支持是治疗的基础;糖皮质激素对肺部病灶的吸收有一定疗效,使用剂量有待进一步探讨;A/H5N1病毒疫苗免疫血浆治疗可能对改善患者的预后有一定帮助.
目的 探索高緻病性禽流感A/H5N1病毒感染(簡稱人禽流感)病例的臨床特點及治療體會.方法 對2009年1月17口山西省太原市第四人民醫院收治的1例人禽流感患者的臨床錶現、實驗室檢查、影像學改變及治療方法等進行總結.結果 患者鼻嚥抽取物A/H5N1病毒經逆轉錄聚閤酶鏈反應(RT-PCR)、實時PCR榆測A/H5N1病毒覈痠暘性,確診為人禽流感病例.患兒女,2歲11箇月,體重11 kg.患兒平素體健,髮病的有活禽屠宰市場環境暴露史.以髮熱、咳嗽、呼吸睏難為主要癥狀;肺部病竈進展快,病程第8天肺部病變迅速進展,x線胸片呈"白肺",病情迅速進展為ARDS,靜脈應用甲潑尼龍165 mg(15 mg·kg-1·d-1)及無創通氣治療,病程第9天病情有所好轉,肺部病竈明顯吸收;病程第11天開始給予奧司他韋及100 ml高滴度A/H5N1病毒疫苗免疫血漿,後患者病情日見好轉,氧閤指數及各種酶學指標恢複正常,肺內病竈明顯吸收;病程第28大患者好轉齣院.結論 人禽流感髮現晚、病情重、進展快,臨床主要錶現為嚴重的ARDS;有效的氧療及呼吸支持是治療的基礎;糖皮質激素對肺部病竈的吸收有一定療效,使用劑量有待進一步探討;A/H5N1病毒疫苗免疫血漿治療可能對改善患者的預後有一定幫助.
목적 탐색고치병성금류감A/H5N1병독감염(간칭인금류감)병례적림상특점급치료체회.방법 대2009년1월17구산서성태원시제사인민의원수치적1례인금류감환자적림상표현、실험실검사、영상학개변급치료방법등진행총결.결과 환자비인추취물A/H5N1병독경역전록취합매련반응(RT-PCR)、실시PCR유측A/H5N1병독핵산양성,학진위인금류감병례.환인녀,2세11개월,체중11 kg.환인평소체건,발병적유활금도재시장배경폭로사.이발열、해수、호흡곤난위주요증상;폐부병조진전쾌,병정제8천폐부병변신속진전,x선흉편정"백폐",병정신속진전위ARDS,정맥응용갑발니룡165 mg(15 mg·kg-1·d-1)급무창통기치료,병정제9천병정유소호전,폐부병조명현흡수;병정제11천개시급여오사타위급100 ml고적도A/H5N1병독역묘면역혈장,후환자병정일견호전,양합지수급각충매학지표회복정상,폐내병조명현흡수;병정제28대환자호전출원.결론 인금류감발현만、병정중、진전쾌,림상주요표현위엄중적ARDS;유효적양료급호흡지지시치료적기출;당피질격소대폐부병조적흡수유일정료효,사용제량유대진일보탐토;A/H5N1병독역묘면역혈장치료가능대개선환자적예후유일정방조.
Objective To explore the clinical features and treatment strategy of human influenza A (H5N1) virus infection.Methods The clinical data from a 2 year-old girl with A/H5N1 infection were collected and analyzed.Results The patient had a history of exposure to a living poultry market.A/H5N1 nucleic acid was detected by real-time polymerase chain reaction and reverse-transcription polymerase chain reaction in a nasopharyngeal aspirate.The prominent clinical features included fever,cough and dyspnea.Extensive multiple lobular infiltrates developed quickly,followed by acute respiratory distress syndrome (ARDS) and muhi-organ dysfunction.Cortcosteroids,oxygen therapy and non-invasive mechanical ventilation were administrated on day 9 after onset of the disease.The patient' s condition became stable after the management.After A/H5N1infection was confirmed,antiviral treatment with oseltamivir and A/H5N1 vaccinated plasma were used on day 11.Oxgenation and serum enzyme levels returned to normal gradually,and most of the lung infiltrates disappeared.The patient was discharged on day 28.Condusioa Human A/H5N1infection is a severe and rapidly progressive disease mostly manifested as ARDS.Corticosteroids may have some effects on the pulmonary lesions,but oxygen therapy and ventilatory support are the mainstay of the management.A/H5N1 vaccinated plasma may be useful for improving the prognosis.
