河北省首例人感染H7N9禽流感重症患者的成功救治并文献复习  

Treatment and literature review of first case of severe human infection with avian influenza H7N9 virus in Hebei province

作　　者：彭丽[1] 王金荣[1] 亢宏山[1] 张谨超[1] 张建军[1] 赵媛媛[1] 崔朝勃[1] Peng Li, Wang Jinrong, Kang Hongshan, Zhang Jinchao, Zhang Jianjun, Zhao Yuanyuan, Cui Zhaobo.(Department of Critical Care Medicine, Harrison International Peace Hospital Affiliated to Hebei Medical University, Hengshui 053000, Chin)

机构地区：[1]河北医科大学附属衡水哈励逊国际和平医院重症医学科,053000

出　　处：《国际呼吸杂志》2018年第6期408-413,共6页International Journal of Respiration

基　　金：河北省2013年医学科学研究重点课题计划项目（20130344）

摘　　要：目的 探讨人感染 H7N9禽流感重症患者的临床特点以提高临床医师对本病的认识,降低病死率。方法 对我科收治的河北省首例确诊人感染 H7N9禽流感重症患者的临床表现、实验室检查、影像学特点、治疗措施进行回顾性病例分析及文献复习。结果 本例患者为57岁男性,因发热、喘憋、胸闷入院,病程进展急骤,迅速出现急性呼吸窘迫综合征 （ARDS）、感染性休克、多脏器功能障碍综合征 （MODS）,经抗病毒、呼吸机辅助呼吸、血液净化等综合治疗后好转顺利出院。结论 人感染 H7N9禽流感患者早期发病临床表现不典型,易误诊为普通肺炎,但病情进展迅速,易合并出现ARDS、感染性休克、MODS等,治疗难度大,早期抗病毒治疗是关键,同时实行肺保护性通气策略、关注多脏器功能、多学科协助合作是成功救治的保证。Objective To investigate the clinical features of critically ill patients infected with HTN9 avian influenza to improve the understanding of the disease and reduce the fatality rate. Methods The clinical manifestations, laboratory examination, imaging features, and treatment measures of the first confirmed case infected with avian influenza HTN9 virus was analyzed retrospectively and reviewed. Results The patient was 57 years old, he was admitted into hospital with fever, shortness of breath, and chest tightness, His condition progressed rapidly, acute respiratory distress syndrome, septic shock and multiple organ dysfunction syndrome were manifested in short term, he was discharged smoothly with antiviral, ventilator, blood purification. Conclusions The early clinical manifestations of HTN9 avian influenza are not typical. It is easily misdiagnosed as pneumonia,but the disease progressed rapidly. Acute respiratory distress syndrome, septic shock and multiple organ dysfunction syndrome are manifested in short term. Early antiviral treatment is the key treatment, which should be combined with lung protective ventilation strategy. Focus on multiple organ function, multidisciplinary collahoration are the guarantee of successful treatment.

关 键 词：流感病毒A型 H7N9亚型 人 感染 急性呼吸窘迫综合征 感染性休克 

分 类 号：R511.7[医药卫生—内科学]