人感染H7N9禽流感抗病毒治疗护理要点解析

Analysis of the therapeutic nursing points of human infection with avian influenza A （H7N9）

目的探讨人感染H7N9禽流感抗病毒治疗的护理要点。方法分析2017年3月至6月遵义医学院附属医院重症医学科（ICU）参与救治的6例人感染H7N9禽流感患者的临床资料。患者均给予抗炎、免疫调节等支持治疗，同时采取抗病毒治疗护理措施，在奥司他韦口服及雾化吸人治疗过程中，建立药物使用登记表并全方位监督执行，如联合静脉用药时严格执行输液计划，严密监测液体负荷和肝功能；避免连续性肾脏替代治疗（CRRT）过滤抗病毒药物，以保证血药浓度。观察患者临床疗效及预后。结果经综合治疗联合抗病毒治疗护理后，5例患者于人院7—22d呼吸道标本病毒核酸检测转为阴性，ICU住院时间（34．20±28．10）d：1例重症患者出现多器官功能障碍综合征（MODS）、感染性休克、弥散性血管内凝血（DIC）、气胸，人院3d后死亡。结论为提高抗病毒治疗的有效性，可建立药物使用登记表并全方位监督执行；采用多种形式提高血、肺部奥司他韦等抗病毒药物浓度，如口服、静脉用药和雾化吸人，并严密监测，防止出现严重并发症；在CRRT治疗过程中有计划地进行抗病毒治疗，以保证血药浓度。

Objective To discuss the therapeutic nursing points of human infection with avian influenza A （H7Ng）. Methods The clinical data of 6 patients with H7N9 avian influenza admitted to intensive care unit （ICU） of Affiliated Hospital of Zunyi Medical College, who had admitted from March to June in 2017 were analyzed. All patients were treated with anti-inflammatory, immunomodulatory and other supportive care while taking antiretroviral treatment and care measures. In the therapy of oseltamivir oral and atomized inhalation, the registration form was established for drug usage and carried out under multi-party supervision. When using intravenous medication, implement infusion was planned strictly, and fluid load and liver function were monitored closely. Continuous renal replacement therapy （CRRT） treatment was avoided to ensure blood drug concentration of antivirals. The clinical effect and prognosis of the patients were observed. Results After comprehensive treatment combined with antiviral therapeutic nursing, the respiratory specimens of 5 patients were turn into negative for viral nucleic acid test in 7-22 days, with average length of ICU stay of （34.20± 28.10） days. One patient died 3 days after admission due to multiple organ dysfunction syndrome （MODS）, septic shock, disseminated intravascular coagulation （DIC）, and pneumothorax. Conclusions To improve the effectiveness of antiviral treatment, we can establish registration form for drug use and carry out under multi-party supervision. To increase the concentration of blood and pulmonary oseltamivir and other antiviral drugs, multiple forms such as oral administration, intravenous administration, and atomization inhalation are used. Meanwhile it should be closely monitored to prevent serious complications. During the continuous treatment of CRRT, there should be antiviral treatment accordingly to ensure the blood concentration.