中东呼吸综合征病例诊疗方案文档.ppt

病例处置 （三）出院标准 体温基本正常、临床症状好转，病原学检测间隔2-4天，连续两次阴性，可出院或转至其他相应科室治疗其他疾病。 * 未解除隔离的患者死亡后，应当及时对尸体进行处理。 处理方法为：用双层布单包裹尸体，装入双层尸体袋中，由专用车辆直接送至指定地点火化； 因民族习惯和宗教信仰不能进行火化的，应当经上述处理后，按照规定深埋。 病例处置 * 密切接触者 （一）现阶段，对确诊病例和临床诊断病例的密切接触者实施医学观察。 （二）对疑似病例的密切接触者，要及时进行登记并开展健康随访，告知本人一旦出现发热、咳嗽、腹泻等症状，要立即通知当地开展健康随访的卫生计生部门。 病例处置 * 预 防 管理传染源 隔离患者 集中医学观察确诊病例及临床诊断病例的密切接触者 健康随访疑似病例的密切接触者 切断传播途径 采取有效的防护措施标准预防+额外预防（飞沫预防+接触预防）相结合的原则 宣教：注意个人卫生，避免接触传染源， 保护易感人群 特异性免疫 无疫苗 非特异性免疫 加强段增强体力 * * 大家好，我是传染病学教研室陈延平。很高兴认识诸位，并能一起学习。但愿通过这个机会，我们都能有所收获，并成为朋友。 * Since 20 May 2015, 18 cases of MERS-CoV have been reported by the Republic of Korea (17) and China (1). All cases are epidemiologically linked to the first case that became ill in the Republic of Korea following travel to the Middle East. This is the first cluster of MERS-CoV cases in the Western Pacific Region and the first MERS-CoV cases reported in the Republic of Korea and China. The cluster is not unusual and is similar to healthcare setting clusters of MERS-CoV in other countries. Adequate IPC measures have ended transmission in previous clusters. Previously, Malaysia and the Philippines were the only Member States in the Western Pacific Region to have reported laboratory confirmed cases of MERS-CoV (one case each). Contact tracing and monitoring by health authorities from the Republic of Korea and China are ongoing. Timely information sharing of cases with WHO is also occurring. WHO has established an Event Management Team (EMT) in response to the cluster, and will continue to provide technical support, as needed. WHO is facilitating timely information sharing of the event through the Event Information Site (EIS) and Disease Outbreak News (DON) website. * * * （3）多脏器衰竭 炎症细胞激活以及释放介质以形成细胞因子网络，诱发多种致病机制相互作用，使得毛细血管膜通透性增高，导致氧耗-氧供平衡失常，并最终可导致ARDS和多器官功能衰竭的发生。 细胞因子风暴是引起急性呼吸窘迫综合症和多器官衰竭的重要原因之一。 发病机理 * ARDS病理 病理改变： 肺广泛充血水肿和肺泡内透明膜形成。 病理过程： 渗出期、增生期、纤维化期。 镜下所见： 肺为紫红色或暗红色，水肿、出血、充血、微血栓形成、间质和肺泡水肿、透明膜形成。 发病机理 正常肺 ARDS肺 * 肺微血管充血、出血、微血栓、肺间质和肺泡内有蛋白质水肿液及炎性细胞浸润 发病