疑似或可能埃博拉病毒病患者32例的医学观察及诊治体会

Suspected or probable Ebola virus disease cases in Liberia:medical observation and treatment experience of 32 cases

目的总结埃博拉治疗中心（Ebola Treatment Unit,ETU）4级防护隔离条件下对疑似或可能埃博拉病毒病（EVD）患者进行医学观察和临床诊治的体会。方法选取2015年1月14至3月14日利比里亚中国ETU留观收治的32例疑似或可能EVD患者为研究对象,医生在4级个人防护隔离条件下查房,以询问病史为主要诊断疾病依据,给予双氢青蒿素哌喹片（3片,1次/d）、左氧氟沙星（0.5g,1次/d）、多维元素善存片（1片,1次/d）、口服补液盐Ⅲ（2包,3次/d）、全能营养素（40g,3次/d）为基础用药联合对症处理的经验性治疗。采用回顾性方法对患者流行病学史、临床症状及体征、诊断、治疗措施、疾病转归及不良反应等临床资料进行分析。结果 32例患者平均年龄（40.53±13.89）岁（14~83岁）,男22例、女10例。发病后就诊时间中位数4.5（1~30）d。所有患者均有发热,平均最高体温（38.36±1.01）℃。主要伴随症状包括乏力25例（78.12%）、关节肌肉酸痛22例（68.75%）、恶心呕吐17例（53.12%）、头痛16例（50.00%）、食欲下降15例（46.88%）、腹泻14例（43.75%）、腹痛14例（43.75%）、咳嗽12例（37.50%）、胸痛10例（31.25%）、呼吸困难5例（15.62%）、吞咽困难4例（12.50%）、呃逆3例（9.38%）、消化道出血2例（6.25%）。32例患者平均住院时间（3.94±2.29）d。出院诊断包括急性胃肠炎13例,急性呼吸道感染7例,上消化道出血1例,腹水原因待查、肝癌可能1例,黄疸原因待查、肝炎可能1例,哮喘急性发作1例,疟疾1例,不完全性肠梗阻1例。26例好转出院,6例死亡,好转率81.25%（26/32）。体温恢复到正常者23例,平均发热恢复正常时间（3.51±1.60）d。患者未出现治疗无法耐受现象及严重不良反应。结论在ETU对疑似或可能EVD患者进行密切医学观察并熟练扎实地应用问诊、查体等医学基本功是诊断疾病的重要手段;经验性口服药物治疗联合对症处理安全、有效,具有一定的临床应用价值。

Objective To summarize our experience on medical observation and treatment of 32 cases with suspected or probable Ebola virus disease（EVD）under level 4personnel bio-protective condition in Liberia.Methods A total 32 suspected or probable EVD cases admitted in China Ebola Treatment Unit（ETU）in Liberia during January 14,2015 to March 14 were included in the present study.The doctors made the ward rounds under level 4personal bio-protective conditions.They were diagnosed by inquiring the detailed history and performing partial physical examination,and were given dihydroartemisinin piperaquine phosphate tablets（3tablets,1/d）,levofloxacin（0.5g,1/d）,centrum（1tablet,1/d）,oral rehydration saltⅢ（2bags,3/d）,and nutrients（40g,3/d）as basic treatments initially combined with supportive medication,which was aimed to relieve their symptoms.The clinical data,including the epidemiologic history,clinical symptoms and signs,diagnosis,treatment efficiency and adverse effects were retrospectively analyzed.Results The mean age of the 32 patients was（40.53±13.89）years old（ranging 14-83）,with 22 males and 10 females.The average time after the onset of illness was 4.5（1-30）d.All the patients had fever,with the average maximum temperature being（38.36±1.01）℃.The main symptoms included fatigue in 25cases（78.12%）,joint/muscle pain in 22patients（68.75%）,nausea/vomiting in 17cases（53.12%）,headache in16cases（50.00%）,anorexia/loss of appetite in 15cases（46.88%）,diarrhea in 14cases（43.75%）,abdominal pain in 14cases（43.75%）,cough in 12cases（37.50%）,chest pain in 10cases（31.25%）,dyspnea in 5cases（15.62%）,dysphagia in4cases（12.50%）,hiccup in 3cases（9.38%）,and gastrointestinal hemorrhage in 2cases（6.25%）.The mean time of hospitalization was（3.94±2.29）d.The final clinical diagnosis were：acute gastroenteritis in 13 cases,acute respiratory tract infection in 7cases,upper gastrointestinal bleeding in 1case,ascites of unknown cause（suspected hepatoma）in 1case,jaundice of unknown cause in 1case,asthma exacerbation in 1case,malaria in 1case,and incomplete intestinal obstruction in 1case.Twenty-six cases were discharged and 6cases died,showing an improvement rate of 81.25%（26/32）.The temperature restored the normal level in 23 cases and the mean time it took was（3.51±1.60）d.The treatment was tolerable and there were no severe side effects.Conclusion Close medical observation,professional inquiry and physical examination are important methods to make clinical diagnosis for suspected Ebola cases in ETU.Empiric therapy with oral drugs combined with supportive therapy is safe and effective for suspected or probable EVD patients in Liberia.