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目的总结2005年中国首例确诊并救治成功的人禽流感肺炎病例的临床特征、诊疗经验。方法分析我院收治抢救的中国大陆首例人禽流感肺炎病例的临床资料,总结其临床特点、诊疗体会。结果本例为9岁男孩,急性起病,但早期症状与普通呼吸道感染相似,早期症状轻,表现为发热、干咳,卡他症状不明显,容易被忽视而耽误治疗;5~7 d进入进展期后,有进展快,肺部改变严重及血象白细胞低的特点。本例初期体温中度升高,能坚持上学;病程第7天病情加重,体温高,达40℃,精神差,伴气促,肺部湿啰音明显,胸片双肺呈现大片致密影,周围血象低,白细胞最低为2.81×109/L,分类以中性核粒细胞为主。给予抗病毒和糖皮质激素等综合治疗,体温在入院后第3天降至正常,胸片于第5天开始吸收,血白细胞于第6天恢复正常。未出现特殊并发症。在病程中早期禽流感病毒(H5N1)核酸检测阴性,通过恢复期血清抗体4倍升高而确诊。本例没有使用达菲,服用金刚烷胺、利巴韦林5 d,同时采取抗感染和小剂量糖皮质激素3周等综合治疗痊愈出院。结论早期重视流行病学调查,可以达到人禽流感肺炎的早发现和早诊断,应用有效治疗可控制病情和改善预后。
Objective To summarize the clinical features, experience of diagnosis and treatment of human bird flu pneumonia in China, which was the first confirmed case in 2005 in China. Methods The clinical data of the first case of human bird flu pneumonia in mainland China treated in our hospital were analyzed and their clinical features, diagnosis and treatment experiences were summarized. Results This case was a 9-year-old boy who developed acute onset. However, the early symptoms were similar to those of the common respiratory tract infection. The early symptoms were mild and manifested as fever and dry cough. The symptoms of catarrhal were not obvious and were easily overlooked and delayed treatment. After the period, there is progress, severe lung changes and low blood leukocyte characteristics. In this case, the body temperature increased moderately and could go to school. On the 7th day, the disease was exacerbated, body temperature was high, reached 40 ℃, poor spirit, with shortness of breath, obvious pulmonary wet rales, Peripheral blood low, the lowest leukocyte 2.81 × 109 / L, classification of neutrophil-based. Given antiviral and glucocorticoid treatment, body temperature dropped to normal on the third day after admission, chest X-ray absorption began on the 5th day, and white blood cells returned to normal on the 6th day. No special complication occurred. During the course of the disease, early detection of avian influenza virus (H5N1) nucleic acid was negative and was confirmed by a 4-fold increase of serum antibody during the recovery phase. This example did not use Tamiflu, taking amantadine, ribavirin 5 d, while taking anti-infective and low-dose glucocorticoid 3 weeks and other comprehensive treatment was discharged. Conclusion Early emphasis on epidemiological investigation can achieve the early detection and early diagnosis of human bird flu pneumonia. Effective treatment can be used to control the disease and improve the prognosis.