河北省首例重症人感染H7N9禽流感的救治体会

Treatment of the first serious case of H7N9 avian influenza in Hebei Province

目的 探讨重症人感染H7N9禽流感患者的临床特点、诊治和预后,以提高临床诊治水平.方法 分析哈励逊国际和平医院重症医学科收治的河北省首例重症人感染H7N9禽流感患者的临床、检验、影像学特点及治疗.结果 患者以发热、喘憋、胸闷起病,病程进展快,很快出现ARDS、感染性休克、多器官功能障碍综合征（MODS）,给予血流动力学监测、抗病毒、糖皮质激素、机械通气、连续肾脏替代疗法、容量管理、保证组织灌注、保护各脏器功能、镇静镇痛等综合治疗后患者临床治愈.结论 重症人感染H7N9禽流感临床迅速进展,易合并ARDS、MODS,如果能早期识别,仍然是可控、可治的.

Objective To explore the clinical characteristics ,diagnosis ,treatment and prognosis of severe avian influenza H7N9 infection ,to improve the level of clinical diagnosis and treatment .Methods Clinical materials ,laboratory ,imaging manifestations and treatment of the first serious case of H 7N9 avian influenza in Hebei Province infected Department of Critical Care Medicine Harrison International Peace Hospital were analyzed .Results The patient with fever ,dyspnea ,chest tightness onset ,rapid progression of the disease ,soon appeared ARDS ,septic shock ,and multiple organ dysfunction syndrome （ MODS） . They were given hemodynamic monitoring ,anti-virus ,corticosteroids ,mechanical ventilation ,continuous renal replacement therapy ,capacity management ,to ensure tissue perfusion ,protection of various organ function ,sedation and analgesia ,and other comprehensive treatment .They were clinical cured .Conclusions Severe avian influenza H7N9 infection is progressing rapidly and is easy to merge with ARDS and M ODS .If it is identified early ,it is still controllable and treatable .