贵州省首例高致病性禽流感A／H5N1病毒感染患者的救治体会  

Clinical investigation of the clinical management and therapeutic stretagies to the first human case infected by influenza A/H5N1 in Guizhou Province

作　　者：张湘燕[1] 刘兰[2] 王建怡[1] 冯端兴[1] 刘维佳[1] 胡延东[2] 周航[3] 舒跃龙[3] 李兴旺[4] 高占成[5] 

机构地区：[1]贵州省人民医院呼吸内科,贵阳550002 [2]贵州省人民医院危重症医学科,贵阳550002 [3]中国疾病预防控制中心 [4]北京地坛医院 [5]北京大学人民医院呼吸和危重症医学科

出　　处：《中华结核和呼吸杂志》2009年第5期342-346,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨成功救治高致病性禽流感A／H5N1病毒感染（简称人禽流感）患者的诊断流程和临床管理措施。方法对2009年1月16日贵州省人民医院收治的1例人禽流感患者的临床表现、实验室检查、心电图、影像学改变和临床管理等资料进行总结。结果经逆转录-聚合酶链反应（RT-PCR）方法和病毒分离确诊为人禽流感病例。患者男，29岁，平素体健，发病前有活禽市场环境暴露史，以发热、畏寒起病，无明显流感样症状，高热时伴有肢体抽搐和意识障碍，继之出现咳嗽，咳大量粉红色泡沫样痰，病情进行性加重，先后出现呼吸困难、急性呼吸窘迫综合征和心房颤动，影像学显示双侧肺炎进行性加重，并伴双侧胸腔积液。病程第8天给予有创呼吸机治疗，并给予奥司他韦，但病情仍进一步加重。病程第10天给予高滴度A／H5N1病毒疫苗免疫血浆后，患者病情日见好转，呼吸道症状逐渐减少甚至消失，心房纤颤转为窦性心率，病程第23天肺内病灶明显吸收后好转出院。结论人禽流感患者发病可无典型的流行病学史，病变进展为急性呼吸窘迫综合征合并心脏损害时病情危重，预后不佳；如能在2周内及时给予适当的病毒免疫血浆治疗，则可能迅速改善患者的预后。Objective To explore the optimized clinical management and therapeutic strategies for the survived human case infected by influenza A（A/H5N1 ）. Methods All the data of the first human case infected by A/H5N1 in Guizhou province was collected and analyzed. Results The first case infected by A/H5N1 in Guizhou Province was confirmed by laboratory findings with reverse-transcription polymerase chain reaction（RT-PCR） and A/H5N1 isolation. Patient was healthy in the past and exposed in the environment of living poultry. The initial symptoms was high fever without influenza-like presentation, but with extremity hyperspasmia and conscious disturbance sometimes. A productive cough with a large mount of pink foaming sputum then appeared. The clinical situation was rapidly deteriorated with dyspnea, acute respiratory distress syndrome and atrial fibrillation. Multiple infiltration in bilateral lungs was progressively developed with moderate bilateral pleural effusion. Invasive ventilation was intervened since ARDS on day 8 after sickness. Oseltamivir was kicked off since day 9 after sickness. However, the clinical condition was still exacerbated. High titering antibody of A/H5N1 vaccinated plasma was administrated on day 10 after sickness. The clinical condition （including oxygen saturation, respiratory symptoms, etc. ） was improved rapidly. The weaning of ventilation was carried out in two days. Atrial fibrillation was back to normal. The patient was clinical recovery and was discharged from hospital on day 23 after sickness. Conclusions The prognosis was poor if A/H5N1 infected human cases developed as acute respiratory distress syndrome withheart injury. However, it could be ameliorated if the plasma of A/H5N1 vaccinated neutrolizing antibody was administrated in time or within two weeks after sickness.

关 键 词：禽流感 流感病毒A型 呼吸窘迫综合征 成人 免疫血浆 

分 类 号：R686[医药卫生—骨科学]