山西省首例高致病性禽流感A／H5N1病毒感染患者的救治体会  

Clinical experience of successful management of a child with A/H5N1 infection in Shanxi province

作　　者：罗宏[1] 范梦柏[1] 曹彬[2] 钱素云[3] 宋承平 赵爱斌[1] 刘克战[4] 张卓彦[1] 王朝海[4] 郝国平[4] 毕惠君 

机构地区：[1]山西省太原市第四人民医院呼吸科,030053 [2]首都医科大学附属北京朝阳医院医院感染和临床微生物科 [3]北京儿童医院危重症监护病房 [4]山西省儿童医院

出　　处：《中华结核和呼吸杂志》2009年第5期351-355,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：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日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检测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11kg。患儿平素体健，发病前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165mg（15mg·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100ml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天患者好转出院。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。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 multi-organ dysfunction. Corteosteroids, 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/H5N1 infection 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. Conclusion Human A/ H5N1 infection 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.

关 键 词：禽流感 呼吸窘迫综合征 成人 糖皮质激素类 免疫血浆 

分 类 号：R686[医药卫生—骨科学]