摘要目的 探索高致病性禽流感A/H5N1病毒感染(简称人禽流感)病例的临床特点及治疗体会.方法 对2009年1月17口山西省太原市第四人民医院收治的1例人禽流感患者的临床表现、实验室检查、影像学改变及治疗方法等进行总结.结果 患者鼻咽抽取物A/H5N1病毒经逆转录聚合酶链反应(RT-PCR)、实时PCR榆测A/H5N1病毒核酸阳性,确诊为人禽流感病例.患儿女,2岁11个月,体重11 kg.患儿平素体健,发病的有活禽屠宰市场环境暴露史.以发热、咳嗽、呼吸困难为主要症状;肺部病灶进展快,病程第8天肺部病变迅速进展,x线胸片呈"白肺",病情迅速进展为ARDS,静脉应用甲泼尼龙165 mg(15 mg·kg-1·d-1)及无创通气治疗,病程第9天病情有所好转,肺部病灶明显吸收;病程第11天开始给予奥司他韦及100 ml高滴度A/H5N1病毒疫苗免疫血浆,后患者病情日见好转,氧合指数及各种酶学指标恢复正常,肺内病灶明显吸收;病程第28大患者好转出院.结论 人禽流感发现晚、病情重、进展快,临床主要表现为严重的ARDS;有效的氧疗及呼吸支持是治疗的基础;糖皮质激素对肺部病灶的吸收有一定疗效,使用剂量有待进一步探讨;A/H5N1病毒疫苗免疫血浆治疗可能对改善患者的预后有一定帮助.

abstractsObjective To explore the clinical features and treatment strategy of human influenza A (H5N1) virus infection.Methods The clinical data from a 2 year-old girl with A/H5N1 infection were collected and analyzed.Results The patient had a history of exposure to a living poultry market.A/H5N1 nucleic acid was detected by real-time polymerase chain reaction and reverse-transcription polymerase chain reaction in a nasopharyngeal aspirate.The prominent clinical features included fever,cough and dyspnea.Extensive multiple lobular infiltrates developed quickly,followed by acute respiratory distress syndrome (ARDS) and muhi-organ dysfunction.Cortcosteroids,oxygen therapy and non-invasive mechanical ventilation were administrated on day 9 after onset of the disease.The patient' s condition became stable after the management.After A/H5N1infection was confirmed,antiviral treatment with oseltamivir and A/H5N1 vaccinated plasma were used on day 11.Oxgenation and serum enzyme levels returned to normal gradually,and most of the lung infiltrates disappeared.The patient was discharged on day 28.Condusioa Human A/H5N1infection is a severe and rapidly progressive disease mostly manifested as ARDS.Corticosteroids may have some effects on the pulmonary lesions,but oxygen therapy and ventilatory support are the mainstay of the management.A/H5N1 vaccinated plasma may be useful for improving the prognosis.