(精选)【医学课件】重症甲型H1NI流感早期诊断和救治(86p)教学课件.pptVIP

重症甲型H1NI流感早期诊断和救治;;内容提要;临床表现;实验室检查 ;什么是重症甲型H1N1？;重症甲型H1NI流感(中国卫生部);;;内容提要; Two pathway Direct injury SIRS: inflammatory storm ;甲型H1N1流感病毒和季节性H1N1的区别;Virus shedding from the nose and throat of inoculated animals;Virus titers in the respiratory tract tissues of ferrets inoculated with seasonal and 2009 A(H1N1) influenza viruses. Virus titers in nasal turbinates, trachea, and lung were determinedby means of end-point titration in MDCK cells. No virus was detected in liver, spleen, kidney, and brain tissue for either virus `;;N Engl J Med 2009;361:680-9.;甲型H1N1 －能在人与人之间传播 －易产生严重的临床症状 －易累及上呼吸道和肺， －不易累及liver, spleen, kidney, and brain －可累及肌肉、心肌和肝脏 ;内容提要;;;重症患者的 年龄分布 Mexico vs China;;Fever, with Temperatures higher than 38°C, cough in ALL pats Dyspnea Or respiratory distress in ALL pats SpO2: 71% (room air) Wheezing: two patients (11%) Diarrhea: Four of the five children (all under 14 years of age) APACHE II: 14 (range, 4 to 32) Sequential Organ Failure Assessment: 6 (range, 1 to 13) ;Fever, with Temperatures higher than 38°C, cough in ALL pats Dyspnea or respiratory distress in ALL pats SpO2: 56% (room air) Wheezing: two patients ;;重症患者的早期线索;;;;重症患者的早期线索;重症患者的临床特征 in Mexico ;Radiologically confirmed pneumonia Bilateral patchy alveolar opacities (predominantly basal) OR Linear, reticular, or nodular shadows (interstitial opacities) Affect three or four lung quadrants in 11 pats.;;;;Cough and fever (3) blood in sputum (1) Sudden onset of symptom (3) Dyspnea and respir distress(3) MV on admission (3) Hypotension (1?) Ventricular fibrillation/Cardiac arrest Hepatic dysfunction (2);Radiologically confirmed pneumonia ;Increased LDH and CK (2) WBC: normal or increased (3) Lymphopenia: ? ; 临床特征;病毒RNA阳性\载量 vs 严重程度;The clinical course of Severe H1N1 influenza A;内容提要;严密监测 治疗重点提前 遏制病毒的复制与炎症反应风暴 预防ARDS和呼吸衰竭 对于已发生MODS 强化治疗和支持衰竭的多个器官 ;Patients require symptomatic treatment only 抗病毒治疗药物 对症治疗：发热、呕吐、腹泻等处理 注意??除其他感染性和神经系统疾病 发病3～5天后继发感染的防治(特别是应用激素);重型患者