全球首例人感染H5N6禽流感孕产妇 临床救治分析  

Clinical analysis of the first maternal patient infected with novel avian Influenza A （H5N6） virus in the world

作　　者：凌双[1] 杨春万[1] 李展鹏[1] 林尚奋 李伸展 周建勇[1] 麦玉婵 

机构地区：[1]肇庆市第一人民医院重症医学科,广东肇庆526040

出　　处：《中华危重病急救医学》2016年第11期988-993,共6页Chinese Critical Care Medicine

摘　　要：目的：报道全球首例人感染H5N6禽流感孕产妇的救治经过，探讨人感染H5N6禽流感孕产妇的临床特点及治疗方案。方法2015年12月28日广东省肇庆市人民医院收治1例人感染H5N6禽流感孕产妇，通过患者的临床资料及治疗经过，分析人感染H5N6禽流感的临床特点及治疗方案。结果患者为40岁孕妇，因发热、咳嗽6d入院，入院时孕35周。①发病经过：患者6d前受凉出现发热，以午后及夜间为主，最高体温39.0℃，伴畏寒、寒战，间有单声咳嗽，夜间咳嗽多，无明显咳痰，活动后气促，休息可缓解，无咽痛、鼻塞、流涕、胸闷、胸痛、夜间阵发性呼吸困难，曾3次在当地医院门诊就诊，给予抗菌药物抗感染、退热等对症支持治疗（具体不详）后体温较前下降，但反复。②患者起病前1周有家禽接触史。③辅助检查：入院时血液检查提示白细胞计数正常（7.94s10^9/L），中性粒细胞计数正常（7.42x10^9/L），淋巴细胞绝对值降低（0.44x10^9/L）；动脉血pH值7.441，氧分压68.7mmHg（1mmHg＝0.133kPa），二氧化碳分压23.9mmHg。入院次日患者床旁X线胸片示：双肺纹理增粗、模糊，可见斑片状模糊影，双肺门影增浓。第3天本院咽拭子和痰液病毒核酸检测示H7N9-RNA阴性、H1N1-RNA阴性，禽流感病毒（AIV）-RNA阳性；第4天送检咽拭子和深部痰液至肇庆市疾病预防控制中心，第5天经广东省疾病预防控制中心进行病毒核酸检测显示H5N6-RNA阳性。婴儿出生第3天鼻拭子AIV-RNA阴性，第5天血甲型流感病毒抗体IgM阴性。④治疗措施：入院时予以中流量鼻导管吸氧；第2天患者呼吸频率40次/min，脉搏血氧饱和度0.80，为防止患者缺氧导致胎死宫内行剖宫产术，术后患者转入重症加强治疗病房（ICU）行有创机械通气，吸入氧浓度（FiO2）为1.00；第4天予以体外膜肺氧合（ECMO），奥司他韦150mg鼻饲、每日2Objective To report the treatment of the first maternal patient infected with novel avian Influenza A （H5N6） virus in the world, and to investigate the clinical features and treatment of the maternal patient. Methods On December 28th, 2015, a maternal patient infected with H5N6 virus was admitted to the First Municipal Hospital of Zhaoqing City. The clinical features and treatments of this patient were analyzed. Results ① A 40-year-old fcmale in 35-week gestation was admitted with the complaint of fever and cough for 6 days with the following characteristics： fever 6 days ago after getting a cold, mainly in the afternoon and night, the maximum body temperature was 39 ℃, with chills, shiver, single cough, short of breath after walking 50 meters which could be relieved after having a rest, but no expectoration, sore throat, nasal obstruction, rhinorrhea, chest tightness, chest pain, paroxysmal nocturnal dyspnea. The body temperature could be decreased after taking antibiotic and antipyretic which was prescribed by the doctor in the local hospital, and was repeatedly administrated. ② She had been to the local live poultry market before the onset of fever. ③ Auxiliary examination： on admission, the patient＇s blood test showed that the white blood cell count was normal （7.94x109/L）, the neutrophil was normal （7.42x109/L）, but the lymphocyte was low （0.44x109/L）; it was shown by the arterial blood gas analysis that pH was 7.441, the oxygen partial pressure was 68.7 mmHg （1 mmHg = 0.133 kPa）, and the carbon dioxide partial pressure was 23.9 mmHg. Infiltration was found in the lung by chest X-ray on the 2nd day, specifically, with double lung texture thickening, fuzzy, visible patchy fuzzy shadow, and double lung portal shadow. On the 3rd day, the throat swab specimen and sputum for virus nucleic acid detection of H7N9-RNA was negative, the H1N1-RNA was negative, but the avian influenza virus （AIV）-RNA was positive. The throat swab specimens and sputum for virus nucleic acid detectio

关 键 词：H5N6禽流感 孕产妇 抗病毒 急性呼吸窘迫综合征 体外膜肺氧合 

分 类 号：R714.251[医药卫生—妇产科学]