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The author:(作者)delv
published in(发表于) 2014/1/27 8:54:36
2014 human infection H7N9 avian flu diagnosis and treatment programme

　　Six, treatment

(A) treatment in isolation. Suspected cases and confirmed cases should be treated in isolation at the earliest opportunity.

(B) symptomatic treatment. Oxygen, according to the level of oxygen nasal tube, open face mask can be used and stored oxygen mask for oxygen therapy. Physical cooling of heat, or use antipyretic drugs. Cough and sputum can be given in severe cases of compound liquorice tablets, ambroxol hydrochloride, n-acetylcysteine, codeine antitussive and expectorant medicine.

(C) the antiviral treatment. Anti-influenza drugs should be applied as soon as possible.

1. principle of antiviral drug use.

(1) prior to the use of antiviral drugs should be collecting respiratory tract specimens.

(2) the antiviral drugs should be used within 48 hours of onset as possible.

Key used in the following groups:

① people H7N9 avian flu infection cases;

② influenza a viral antigen testing positive for influenza;

③ rapid detection of influenza a viral antigen-negative of influenza with or without detection, with the following conditions, antiviral drugs should be used:

A。 Have a history of close contact with suspected or confirmed cases (including staff) develop flu-like symptoms;

B。 Clustering of influenza;

C.1 weeks have been exposed to avian influenza;

D。 Chronic heart and lung disease, old age, pregnancy, and other flu-like cases;

E。 Rapid progress and the condition that requires the use of antiviral drugs in the clinical influenza;

F。 Other unexplained cases of pneumonia.

(3) that requires the use of antiviral drugs for clinical cases, even more than 48 hours of the disease should also be used.

2. the neuraminidase inhibitors:

(1) oseltamivir (Oseltamivir): adult dose 75mg 2 times a day, treatment for 5-7 days, severe cases dose can be doubled, treatments can extend more than 1 time. 1 year old or older pediatric patients should be according to the weight of delivery: low weight 15Kg, 30mg 2 times a day; body mass 15~23Kg, 45mg 2 times a day; low weight 23~40Kg, 60mg 2 times a day; body mass larger than 40Kg, 75mg 2 times a day. For children who have difficulty swallowing capsules, the choice of oseltamivir suspension.

(2) palamiwei (Peramivir): severe case or cannot be taken orally available palamiwei sodium chloride injection, dosage for adults is 300~600mg, intravenous infusion, 1 time a day, 1-5 day, severe cases treatment may be extended appropriately. Current clinical data are limited, should be closely observed adverse reactions.

(3) zanamivir (Zanamivir): adults and adolescents aged 7 usage: 2 times per day at an interval of 12 hours each 10mg (inhaled twice).

3. the M2 ion channel blockers: current monitoring data show all H7N9 avian influenza viruses to amantadine (Amantadine) and rimantadine (Rimantadine) resistance, is not recommended.

(D) the treatment based on syndrome differentiation of traditional Chinese medicine.

1. epidemic toxin invading lung, Lung lost vision down syndrome (suspected or confirmed cases of the disease the easy ones).

Symptoms: fever, cough, and few sputum, headache, muscle and joint pain. Mamillata Moss thin veins sliding. Mamillata Moss thin, slippery and rapid pulse.

Treatment method: heat-clearing and detoxifying, xuanfei zhike.

Refer to the prescription and dosage: decoction of yinqiao powder white tiger.

15G Honeysuckle 30g, Hypericum perforatum, 15G fried almonds, raw gypsum 30g

Anemarrhenae 10G, 15G, Phragmites communis Trin 30g, mulberry leaf Artemisia annua 15G

15G, licorice root of scutellaria baicalensis 6g

Water service, daily 1~2, and once every 4-6 hours of oral.

Addition and subtraction: coughing worse with loquat leaves and Fritillaria.

Traditional Chinese medicine: selectable wind jiedu capsules, even the flower of Lianhua qingwen capsule, Jinlian qingre effervescent tablets with detoxification, xuanfei zhike efficacy of drugs.

Chinese medicine injection:, xiyanping injection, by tanreqing injection of reduning injection, xuebijing injection and shenmai injection.

2. the epidemic toxin obstructing lung, outside the closed-off cards (clinical manifestations of fever, acute respiratory distress syndrome, such as septic shock patients).

Symptoms: high fever, cough, sputum slightly less, hold your breath, breath, spit, or slightly pink frothy sputum, not late with four temperature limb acute thoracic pain and dysphoria anxiety, rather then the coma and delirium. Tongue, dark red, deep and thready pulse or pulse light broke.

Therapy: detoxifying xiefei, Qi and solid off.

Refer to the prescription and dosage: Xuan Baicheng soup soup with mg.

Rhubarb 10G, trichosanthes 30g, fried almonds fried tinglizi 10G, 30g

Raw gypsum 30g, Rod 15G, semen raphani gardenia 10G, Tiger 15G

Cornus 15G, Panax quinquefolium 15G

Water service, daily 1~2 dose, oral or tube feeding once every 4-6 hours.

Addition and subtraction:

High fever, vaguely conscious of consciousness, coma and delirium, serve the top of angong niuhuang pill;

Limbs cold and sweating dripping add processed aconite, calcined bone, calcined Oyster;

Traditional Chinese medicine: selectable shenmai injection and shenmai injection, tanreqing injection, of Xue-bi-Jing injection, xiyanping injection, of reduning injection.

3. the above decoction of Chinese herbs, proprietary Chinese medicines and Chinese medicine injection as a preventive use, treated with combination of traditional Chinese and Western medicine should be used early.

(E) strengthen support for the treatment and prevention of complications. Pay attention to rest, drink plenty of water, increasing the nutrient, indigestible diet, maintain a water mass balance. If significant hyponatremia, should supplement sodium chloride. For hypokalemia, potassium chloride, potassium aspartate, potassium treatment. Should keep a close look at patients to monitor and prevent complications. Secondary bacterial infection of antibiotics should clear or when there is sufficient evidence to suggest that secondary bacterial infection.

(F) treatment of severe cases. Specific reference to the human infection H7N9 avian medical expert consensus treatment in severe cases section.

　　Seven, hospital infection control

Strictly regulate admitted people H7N9 avian flu infection in patients with hospital infection prevention and control measures of medical institutions. In accordance with standard principles of prevention, according to the transmission of disease control measures. Specific measures based on the infection H7N9 avian flu infection prevention and control technical guide (2013) of the relevant provisions.

　　Eight, transfer or discharge standards

(A) due to the underlying disease or complications, need longer hospitalization of patients, others H7N9 avian influenza virus nucleic acid test after 2 consecutive negative, can be transferred out of the isolation ward for further treatment.

(B) the temperature is normal, clinical symptoms disappeared, respiratory tract specimens of human infection H7N9 avian influenza virus nucleic acids tested negative 2 times in a row, to be discharged.

(Original title: national health family planning Commission announced H7N9 avian flu infection diagnosis and treatment programme)

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　　六、治疗

　　(一)隔离治疗。对疑似病例和确诊病例应尽早隔离治疗。

　　(二)对症治疗。可吸氧，根据缺氧程度可采用鼻导管、开放面罩及储氧面罩进行氧疗。高热者可进行物理降温，或应用解热药物。咳嗽咳痰严重者可给予复方甘草片、盐酸氨溴索、乙酰半胱氨酸、可待因等止咳祛痰药物。

　　(三)抗病毒治疗。应尽早应用抗流感病毒药物。

　　1.抗病毒药物使用原则。

　　(1)在使用抗病毒药物之前应留取呼吸道标本。

　　(2)抗病毒药物应尽量在发病48小时内使用。

　　重点在以下人群中使用：

　　①人感染H7N9禽流感病例；

　　②甲型流感病毒抗原快速检测阳性的流感样病例；

　　③甲型流感病毒抗原快速检测阴性或无条件检测的流感样病例，具有下列情形者，亦应使用抗病毒药物：

　　A。与疑似或确诊病例有密切接触史者(包括医护人员)出现流感样症状；

　　B。聚集性流感样病例；

　　C.1周内接触过禽类的流感样病例；

　　D。有慢性心肺疾病、高龄、妊娠等情况的流感样病例；

　　E。病情快速进展及临床上认为需要使用抗病毒药物的流感样病例；

　　F。其他不明原因肺炎病例。

　　(3)对于临床认为需要使用抗病毒药物的病例，即使发病超过48小时也应使用。

　　2.神经氨酸酶抑制剂：

　　(1)奥司他韦(Oseltamivir)：成人剂量75mg每日2次，疗程5～7天，重症病例剂量可加倍，疗程可延长一倍以上。1岁及以上年龄的儿童患者应根据体重给药：体重不足15Kg者，予30mg每日2次；体重15～23Kg者，予45mg每日2次；体重不足23～40Kg者，予60mg每日2次；体重大于40Kg者，予75mg每日2次。对于吞咽胶囊有困难的儿童，可选用奥司他韦混悬液。

　　(2)帕拉米韦(Peramivir)：重症病例或无法口服者可用帕拉米韦氯化钠注射液，成人用量为300～600mg，静脉滴注，每日1次，1～5天，重症病例疗程可适当延长。目前临床应用数据有限，应严密观察不良反应。

　　(3)扎那米韦(Zanamivir)：成人及7岁以上青少年用法：每日2次，间隔12小时；每次10mg(分两次吸入)。

　　3.离子通道M2阻滞剂：目前监测资料显示所有H7N9禽流感病毒对金刚烷胺(Amantadine)和金刚乙胺(Rimantadine)耐药，不建议使用。

　　(四)中医药辨证论治。

　　1.疫毒犯肺，肺失宣降证(疑似病例或确诊病例病情轻者)。

　　症状：发热，咳嗽，少痰，头痛，肌肉关节疼痛。舌红苔薄，脉数滑。舌红苔薄，脉滑数。

　　治法：清热解毒，宣肺止咳。

　　参考处方和剂量：银翘散合白虎汤。

　　金银花30g、连翘15g、炒杏仁15g、生石膏30g

　　知母10g、桑叶15g、芦根30g、青蒿15g

　　黄芩15g、生甘草6g

　　水煎服，每日1～2剂，每4～6小时口服一次。

　　加减：咳嗽甚者加枇杷叶、浙贝母。

　　中成药：可选择疏风解毒胶囊、连花清瘟胶囊、金莲清热泡腾片等具有清热解毒，宣肺止咳功效的药物。

　　中药注射液：痰热清注射液、喜炎平注射液、热毒宁注射液、血必净注射液、参麦注射液。

　　2.疫毒壅肺，内闭外脱证(临床表现高热、急性呼吸窘迫综合征、感染性休克等患者)。

　　症状：高热，咳嗽，痰少难咯，憋气，喘促，咯血，或见咯吐粉红色泡沫痰，伴四末不温，四肢厥逆，躁扰不安，甚则神昏谵语。舌暗红，脉沉细数或脉微欲绝。

　　治法：解毒泻肺，益气固脱。

　　参考处方和剂量：宣白承气汤合参萸汤。

　　生大黄10g、全瓜蒌30g、炒杏仁10g、炒葶苈子30g

　　生石膏30g、生栀子10g、虎杖15g、莱菔子15g

　　山萸肉15g、西洋参15g

　　水煎服，每日1～2剂，每4～6小时口服或鼻饲一次。

　　加减：

　　高热、神志恍惚、甚至神昏谵语者，上方送服安宫牛黄丸；

　　肢冷、汗出淋漓者加炮附子、煅龙骨、煅牡蛎；

　　中成药：可选择参麦注射液、参附注射液、痰热清注射液、血必静注射液、喜炎平注射液、热毒宁注射液。

　　3.以上中药汤剂、中成药和中药注射液不作为预防使用，应早期使用中西医结合治疗。

　　(五)加强支持治疗和预防并发症。注意休息、多饮水、增加营养，给予易消化的饮食，维持水电解质平衡。如出现明显低钠血症，应积极补充氯化钠。对于低钾血症，应给予氯化钾、门冬氨酸钾等补钾治疗。须密切观察病情，监测并预防并发症。抗菌药物应在明确继发细菌感染时或有充分证据提示继发细菌感染时使用。

　　(六)重症病例的治疗。具体参照《人感染H7N9禽流感医疗救治专家共识》重症病例的治疗部分。

　　七、医院感染防控

　　严格规范收治人感染H7N9禽流感患者医疗机构的医院感染防控措施。遵照标准预防的原则，根据疾病传播途径采取防控措施。具体措施依据《人感染H7N9禽流感医院感染预防与控制技术指南(2013年版)》的相关规定。

　　八、转科或出院标准

　　(一)因基础疾病或合并症较重，需较长时间住院治疗的患者，待人感染H7N9禽流感病毒核酸检测连续2次阴性后，可转出隔离病房进一步治疗。

　　(二)体温正常，临床症状基本消失，呼吸道标本人感染H7N9禽流感病毒核酸检测连续2次阴性，可以出院。

(原标题：国家卫生计生委公布人感染H7N9禽流感诊疗方案)

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