人高致病性禽流感一例并文献复习  

Avian influenza (H_5N_1) cured successfully in human:a case report

作　　者：李尔然[1] 王秋月[1] 赵亚滨[1] 李振华[1] 刘志[1] 马晓春[2] 康健[3] 

机构地区：[1]中国医科大学附属 [2]中国医科大学附属第一医院外科重症监护病房,沈阳110001 [3]中国医科大学附属第一医院呼吸疾病研究所,沈阳110001

出　　处：《中华内科杂志》2006年第10期820-823,共4页Chinese Journal of Internal Medicine

摘　　要：目的提高临床医师对人禽流感的认识。方法分析辽宁省首例 H_5N_1型人禽流感患者的临床资料及文献复习。结果患者女性,31岁,来自辽宁省黑山县禽流感疫区,发病前与病死鸡有密切接触史,以“发热8 d,咳嗽、气短5 d,腹泻3 d”为主诉于2005年11月7日由黑山县医院转入中国医科大学附属第一医院发热门诊进行隔离治疗。患者入院时呈重症肺炎、呼吸衰竭的表现,入院后末梢血白细胞减少,细胞免疫功能低下,心肌受累,ALT 等多种酶学异常。经积极支持疗法、对症及抗病毒、抗感染治疗,患者病情逐渐好转,于2005年11月29日痊愈出院。该患者于出院后第9天(2005年12月8日)被确诊为 H_5N_1型人禽流感。结论本例高致病性人禽流感的成功救治是多学科密切协作的结果,与恰当的支持、对症治疗以及积极预防和及时处理并发症密不可分。Objective To improve understanding of avian influenza in humans by presenting a case of avian influenza （ H5N1 ）. Methods Clinical and laboratory data of this case of avian influenza （ H5N1 ） in humans were described, and related literature was reviewed. Results The female patient was 31 years old. She lived in epidemic district of avian influenza and had a history of close contact with sick poultry. The patient initially presented fever and chills accompanied by myalgia, and then followed by cough, blood- tinged sputum, dyspnea and frequent diarrhea. Laboratory findings indicated leukopenia, dysfunction of cellular immunity, abnormal enzymes of liver, and hypoxia. Patchy infiltration involved two lungs progressed rapidly on chest radiograph. ECG showed that T waves of V1-5 were reverted. The patient was diagnosed with avian influenza （H5N1 ） by hemagglutination inhibition and microneutralization assay combined with epidemiological and clinical data. Supportive therapy, corticosteroids, antibacterial, and antiviral agents were administered. Complications were treated accordingly during the course. She got better overtime and recovered. The laboratory abnormalities and chest radiograph returned to normal before discharge. The patient＇s relatives and doctors involved in the medical care were free from infection. Conclusions Supportive treatment is important for patients with avian influenza. Complications should be prevented and treated in time.

关 键 词：流感病毒 禽 人类 肺炎 

分 类 号：R512.99[医药卫生—内科学]