2例H5N1型人禽流感救治经验探讨

目的探讨H5N1型人禽流感病例的临床表现，实验室检查变化、影像特征及诊治经验。方法对2005年11月、2006年12月诊治的2例H5N1型人禽流感病例，1例治愈，1例死亡的临床资料作比较分析。结果2例患者以高热、全身疼痛，咳嗽、咳痰为主要症状，发病第6～7天，病情急剧加重，出现呼吸窘迫。白细胞总数正常或下降，中性粒细胞数正常或增高，心肌酶、肝酶明显增高并随病情而变化。胸部X线呈多肺叶病变，短期进展迅速。发病后第7～11天是疾病的高峰期，例1因ARDS合并多脏器功能衰竭，于发病后第13天死亡。例2经有效的呼吸机辅助通气及全身综合治疗，于发病后第27天治愈。2例经中国疾病预防控制中心检测，例1气管分泌物禽流感病毒（H5N1）核酸阳性，例2气管分泌物禽流感病毒（H5N1）核酸和血清抗体均阳性，而确诊为高致病性（H5N1）人禽流感病例。结论人感染高致病性H5N1亚型禽流感是一种病死率高的传染性疾病，重视流行病学调查，早认识、早就诊，出现急性呼吸窘迫时尽早呼吸支持治疗，加强呼吸道管理，重要脏器功能保护，营养支持，预防和控制肺部继发细菌、真菌感染是成功救治的关键。

The study of treatment in two patients with human H5N1 avian influenza

Objective To study the clinical manifestations, laboratory test changes, imaging features and to experience the diagnosis and treatment of the human H5N1 avian influenza.Methods Make a comparing analysis about the clinical information of the two human H5N1 avian influenza cases. one case diagnosed in November 2005 was cured and the other the patient died in December 2006.Results The main signs of the two patients were hyperpyrexia, pain all over the body, cough, expectoration. On the sixth and the seventh day of the disease, patients'condition aggravated rapidly and the respiratory distress appeared. White blood cells (WBC) was normal or decreased, neutrophil was normal or increased. The levels of myocardial enzymes and hepatic enzymes increased apparently and changed with the patients' condition. Chest X-ray presented multiple lung lobes changes which progressed rapidly in a short time. The high peak stage of the disease was around 7-8 day after infection. The first patient died of ARDS complicated with multiple organ failure on the thirteenth day. The other patient was cured by the effective ventilator-assisted breathing and systemic combined therapy on the twenty-seventh day. The two cases were tested by the Chinese center for disease control and prevention. The nucleic acid of avian influenza virus(H5N1) from tracheal excretion in case 1 was positive, and both nucleic acid and serum antibody were positive in case 2 which was finally diagnosed as highly pathogenic human avian influenza.Conclusion Human infection with highly pathogenic H5N1 Subtype avian influenza is an infectious diseases with a high mortality. The key points of successful treatments include emphasizing the epidemiologic research, early diagnosis, early medical visiting, respiratory support as soon as acute respiratory distress is identified, enhancing breath way management, protecting important organs'function, nutrition support, preventing and controlling lung secondary bacterial or fungal infection.