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目的提高临床医师对人禽流感的认识。方法分析辽宁省首例 H_5N_1型人禽流感患者的临床资料及文献复习。结果患者女性,31岁,来自辽宁省黑山县禽流感疫区,发病前与病死鸡有密切接触史,以“发热8 d,咳嗽、气短5 d,腹泻3 d”为主诉于2005年11月7日由黑山县医院转入中国医科大学附属第一医院发热门诊进行隔离治疗。患者入院时呈重症肺炎、呼吸衰竭的表现,入院后末梢血白细胞减少,细胞免疫功能低下,心肌受累,ALT 等多种酶学异常。经积极支持疗法、对症及抗病毒、抗感染治疗,患者病情逐渐好转,于2005年11月29日痊愈出院。该患者于出院后第9天(2005年12月8日)被确诊为 H_5N_1型人禽流感。结论本例高致病性人禽流感的成功救治是多学科密切协作的结果,与恰当的支持、对症治疗以及积极预防和及时处理并发症密不可分。
Objective To improve clinicians’ understanding of human bird flu. Methods The clinical data and literature reviews of the first H_5N_1 human bird flu in Liaoning Province were analyzed. Results The female patient, 31 years old, came from the bird flu epidemic area in Heishan County of Liaoning Province. Before the onset of illness, there was a close contact history with the dead chickens. The main symptoms were “fever 8 days, cough, shortness of breath 5 days, diarrhea 3 days” From Heishan County Hospital on the 7th transferred to the First Affiliated Hospital of China Medical University fever clinic for isolation and treatment. Patients admitted to hospital were severe pneumonia, respiratory failure performance, admission after the reduction of peripheral blood leukopenia, cellular immune dysfunction, myocardial involvement, ALT and other enzymological abnormalities. After actively supporting therapy, symptomatic and antiviral, anti-infective treatment, the patient’s condition gradually improved and was discharged on November 29, 2005. The patient was diagnosed with H5N1 bird flu on the 9th day after discharge (December 8, 2005). Conclusion The successful treatment of the HPAI in this case is the result of close collaboration among multiple disciplines and is closely linked with appropriate support, symptomatic treatment and active prevention and timely management of complications.