英文寫作翻譯頻道為大家整理的關(guān)于h7n9的英語作文：人感染H7N9禽流感診療方案，供大家參考!
H7N9來勢洶洶，人感染H7N9禽流感是由H7N9亞型禽流感病毒引起的急性呼吸道傳染病?，F(xiàn)在我們需要了解H7N9的根本然后來做出相對應的預防措施，下面讓我們來了解一下吧。
H7N9 break in in full fury, human infection with the H7N9 avian influenza is an acute respiratory tract caused by avian influenza H7N9 virus infection. Now we need to understand the H7N9 fundamental and then make the corresponding preventive measures, let us to know about it.
一、病原學
A, etiology
禽流感病毒屬正粘病毒科甲型流感病毒屬。禽甲型流感病毒顆粒呈多形性，其中球形直徑80～120nm，有囊膜。基因組為分節(jié)段單股負鏈RNA。依據(jù)其外膜血凝素(H)和神經(jīng)氨酸酶(N)蛋白抗原性不同，目前可分為16個H亞型(H1～H16)和9個N亞型(N1～N9)。禽甲型流感病毒除感染禽外，還可感染人、豬、馬、水貂和海洋哺乳動物?？筛腥救说那萘鞲胁《緛喰蜑镠5N1、H9N2、H7N7、H7N2、H7N3，此次報道的為人感染H7N9禽流感病毒。該病毒為新型重配病毒，其內(nèi)部基因來自于H9N2禽流感病毒。
Avian influenza virus belonging to Orthomyxoviridae influenza a virus. Avian influenza A virus particles were polymorphic, the spherical diameter of 80 ~ 120nm, capsule. Genome is segmented negative-stranded RNA. On the basis of the outer membrane of hemagglutinin (H) and neuraminidase (N) proteins are antigenically different, can be divided into 16 subtypes of H (H1 to H16) and 9 N subtypes (N1 ~ N9). Avian influenza A virus in avian, can also be infected people, pigs, horses, mink and marine mammals. Infection of human avian influenza virus subtype H5N1, H9N2, H7N7, H7N2, H7N3, the reported human infection with the H7N9 avian influenza virus. This virus was a new reassortant virus, its internal genes from H9N2 avian influenza virus.
禽流感病毒普遍對熱敏感，對低溫抵抗力較強，65℃加熱30分鐘或煮沸(100℃)2分鐘以上可滅活。病毒在較低溫度糞便中可存活1周，在4℃水中可存活1個月，對酸性環(huán)境有一定抵抗力，在pH4.0的條件下也具有一定的存活能力。在有甘油存在的情況下可保持活力1年以上。
Avian influenza virus is sensitive to heat, strong resistance of low temperature, 65 ℃ for 30 minutes or boiling (100 ℃) for more than 2 minutes can be inactivated. The virus in the lower temperature in feces can survive for 1 weeks, in 4 ℃ water can survive for 1 months, have a certain resistance to the acidic environment, but also has a certain ability to survive under the conditions of pH4.0. In the presence of glycerol can keep the activity of 1 years.
二、流行病學
Two, epidemiology
(一)傳染源。目前尚不明確，根據(jù)以往經(jīng)驗及本次病例流行病學調(diào)查，推測可能為攜帶H7N9禽流感病毒的禽類及其分泌物或排泄物。
(a) the source of infection. It is not clear, according to a survey of past experience and the epidemiological, presumably to carry the H7N9 avian influenza virus in poultry and its secretion or excretion.
(二)傳播途徑。經(jīng)呼吸道傳播，也可通過密切接觸感染的禽類分泌物或排泄物等被感染，直接接觸病毒也可被感染。現(xiàn)尚無人與人之間傳播的確切證據(jù)。
(two) transmission. Spread through the respiratory tract, and also can be infected through close contact with infected birds secretion or excretion, direct contact with the virus can also be infected. There is no evidence of communication between now and the.
(三)易感人群。目前尚無確切證據(jù)顯示人類對H7N9禽流感病毒易感?，F(xiàn)有確診病例均為成人。
(three) the susceptible population. At present there is no conclusive evidence of human H7N9 avian influenza virus susceptibility. The confirmed cases were adult.
(四)高危人群 ?，F(xiàn)階段主要是從事禽類養(yǎng)殖、銷售、宰殺、加工業(yè)者，以及在發(fā)病前1周內(nèi)接觸過禽類者。
(four) high risk population. At the present stage is mainly engaged in poultry breeding, slaughter, processing, sales, as well as in the 1 week prior to the onset of contact with poultry.
三、臨床表現(xiàn)
Three, clinical manifestation
根據(jù)流感的潛伏期及現(xiàn)有H7N9禽流感病毒感染病例的調(diào)查結(jié)果，潛伏期一般為7天以內(nèi)。
Based on the results of the investigation during the incubation period and the existing H7N9 avian influenza virus infection, incubation period is generally 7 days.
(一) 一般表現(xiàn)。
(a) the general performance.
患者一般表現(xiàn)為流感樣癥狀，如發(fā)熱，咳嗽，少痰，可伴有頭痛、肌肉酸痛和全身不適。重癥患者病情發(fā)展迅速，表現(xiàn)為重癥肺炎，體溫大多持續(xù)在39℃以上，出現(xiàn)呼吸困難，可伴有咯血痰;可快速進展出現(xiàn)急性呼吸窘迫綜合征、縱隔氣腫、膿毒癥、休克、意識障礙及急性腎損傷等。
Patients typically present with flu-like symptoms, such as fever, cough, less sputum, accompanied by headache, muscle pain and malaise. Patients with severe illness development is rapid, manifested as severe pneumonia, mostly persistent temperature over 39 ℃, difficulty in breathing, may be accompanied by hemoptysis sputum; rapid progress in acute respiratory distress syndrome, mediastinal emphysema, sepsis, shock, disturbance of consciousness and acute kidney injury.
(二)實驗室檢查。
(two) laboratory.
1.血常規(guī)。白細胞總數(shù)一般不高或降低。重癥患者多有白細胞總數(shù)及淋巴細胞減少，并有血小板降低。
1 blood. Total white cell count in general is not high or lower. Many patients with severe and the total number of lymphocytes decreased white blood cells, and platelets.
2.血生化檢查。多有肌酸激酶、乳酸脫氫酶、天門冬氨酸氨基轉(zhuǎn)移酶、丙氨酸氨基轉(zhuǎn)移酶升高，C反應蛋白升高，肌紅蛋白可升高。
2 blood biochemical examination. There are many creatine kinase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase elevated C, elevated C-reactive protein, myoglobin can increase.
3.病原學檢測。
Study 3 pathogen detection.
(1)核酸檢測。對患者呼吸道標本(如鼻咽分泌物、口腔含漱液、氣管吸出物或呼吸道上皮細胞)采用real time PCR(或RT-PCR)檢測到H7N9禽流感病毒核酸。
(1) nucleic acid detection. In patients with respiratory specimens (such as nasopharyngeal secretions, oral gargle, tracheal aspirate or respiratory epithelial cells) using real time PCR (or RT-PCR) to the H7N9 avian influenza virus nucleic acid detection.
(2)病毒分離。從患者呼吸道標本中分離H7N9禽流感病毒。
(2) virus isolation. The separation of H7N9 avian influenza virus from patients with respiratory tract specimens.
(三)胸部影像學檢查。發(fā)生肺炎的患者肺內(nèi)出現(xiàn)片狀影像。重癥患者病變進展迅速，呈雙肺多發(fā)磨玻璃影及肺實變影像，可合并少量胸腔積液。發(fā)生ARDS時，病變分布廣泛。
(three) the chest imaging. Pneumonia patients of lung lamellar image. In patients with severe lesions rapidly, a double multiple pulmonary ground-glass opacity and consolidation of lung image, with a small amount of pleural effusion. The occurrence of ARDS, lesions are widely distributed.
(四)預后。人感染H7N9禽流感重癥患者預后差。影響預后的因素可能包括患者年齡、基礎(chǔ)疾病、合并癥等。
(four) the prognosis. Of human infection with H7N9 avian influenza patients with poor prognosis. Prognostic factors may include patient age, underlying diseases, complications.
四、診斷與鑒別診斷
Four, diagnosis and differential diagnosis
(一)診斷。根據(jù)流行病學接觸史、臨床表現(xiàn)及實驗室檢查結(jié)果，可作出人感染H7N9禽流感的診斷。在流行病學史不詳?shù)那闆r下，根據(jù)臨床表現(xiàn)、輔助檢查和實驗室檢測結(jié)果，特別是從患者呼吸道分泌物標本中分離出H7N9禽流感病毒，或H7N9禽流感病毒核酸檢測陽性，可以診斷。
(a) diagnosis. According to the epidemiological contact history, clinical manifestations and laboratory test results, can make the diagnosis of human infection with the H7N9 avian influenza. In the history of epidemiology of unknown circumstances, according to the detection results of clinical manifestation, auxiliary examination and laboratory, especially H7N9 avian influenza viruses isolated from patients with respiratory tract secretion samples, or nucleic acid of H7N9 avian influenza virus detection, diagnosis.
1.流行病學史。發(fā)病前1周內(nèi)與禽類及其分泌物、排泄物等有接觸史。
1 epidemiological history. 1 week prior to the onset of poultry and its secretion and excretion, contact history.
2.診斷標準。
2 diagnostic standards.
(1)疑似病例：符合上述臨床癥狀及血常規(guī)、生化及胸部影像學特征，甲型流感病毒通用引物陽性并排除了季節(jié)性流感，可以有流行病學接觸史。
(1) cases of suspected: meet the characteristics of the clinical symptoms and blood routine, biochemical and imaging of the chest, influenza virus a universal primer positive and eliminate the seasonal flu, can have the epidemiological contact history.
(2)確診病例：符合疑似病例診斷標準，并且呼吸道分泌物標本中分離出H7N9禽流感病毒或H7N9禽流感病毒核酸檢測陽性。
(2) cases with suspected cases: diagnostic criteria, and respiratory secretion were isolated from H7N9 avian influenza virus or avian H7N9 influenza virus nucleic acid detection positive.
重癥病例：肺炎合并呼吸功能衰竭或其他器官功能衰竭者為重癥病例。
Severe cases: pneumonia complicated with respiratory failure or other organ failure in severe cases.
(二)鑒別診斷。應注意與人感染高致病性H5N1禽流感、季節(jié)性流感(含甲型H1N1流感)、細菌性肺炎、傳染性非典型肺炎(SARS)、新型冠狀病毒肺炎、腺病毒肺炎、衣原體肺炎、支原體肺炎等疾病進行鑒別診斷。鑒別診斷主要依靠病原學檢查。
(two) the differential diagnosis. Attention should be paid to the highly pathogenic H5N1 avian influenza, seasonal flu and human infection (including the influenza a H1N1 influenza), bacterial pneumonia, infectious atypical pneumonia (SARS), a novel coronavirus pneumonia disease, adenovirus pneumonia, Chlamydia pneumoniae, mycoplasma pneumonia, differential diagnosis. Differential diagnosis should mainly rely on the etiological examination.
五、治療
Five, treatment
(一)對臨床診斷和確診患者應進行隔離治療。
(a) for clinical diagnosis and diagnosed patients should be treated in isolation.
(二)對癥治療?？晌酢媒鉄崴?、止咳祛痰藥等。
(two) for symptomatic treatment. Application of oxygen, can be antipyretic, cough expectorant.
(三)抗病毒治療。應盡早應用抗流感病毒藥物。
(three) antiviral treatment. Early application of antiviral drugs.
1.神經(jīng)氨酸酶抑制劑：可選用奧司他韋(Oseltamivir)或扎那米韋(Zanamivir)，臨床應用表明對禽流感病毒H5N1和H1N1感染等有效，推測對人感染H7N9禽流感病毒應有效。奧司他韋成人劑量75mg每日兩次，重癥者劑量可加倍，療程5-7天。扎那米韋成人劑量10mg，每日兩次吸入。
1 neuraminidase inhibitors: use oseltamivir or zanamivir (Oseltamivir) (Zanamivir), clinical application shows that effective against avian influenza virus H5N1 and H1N1 infection, speculated that the effective of human infection with the H7N9 avian influenza virus. Oseltamivir adult dose of 75mg two times a day, severe dose may be doubled, treatment 5-7 days. Zana Mi Vee adult dose 10mg, two times daily intake.
2.離子通道M2阻滯劑：目前實驗室資料提示金剛烷胺(Amantadine)和金剛乙胺(Rimantadine)耐藥，不建議單獨使用。
2 M2 ion channel blocker: the laboratory data suggest that amantadine and rimantadine (Amantadine) (Rimantadine) resistance, is not recommended to use alone.
(四)中醫(yī)藥治療。
(four) treated with traditional Chinese medicine.
1.疫毒犯肺，肺失宣降
1 disease drug lung, lung loses Xuan drop
癥狀：發(fā)熱，咳嗽，少痰，頭痛，肌肉關(guān)節(jié)疼痛。
Symptoms: fever, cough, less sputum, headache, muscle and joint pain.
治法：清熱宣肺
Method: heat Xuanfei
參考處方：
Reference prescription:
桑葉 金銀花 連翹 炒杏仁 生石膏 知母 蘆根 青蒿 黃芩 生甘草
Mulberry leaf honeysuckle and Forsythia Chao Xingren Anemarrhenae Rhizoma Phragmitis gypsum Artemisia Scutellaria Radix Glycyrrhizae
水煎服，每日1—2劑，每4—6小時口服一次。
Shuijianbi, daily 1 - 2, every 4 - 6 hours once oral.
加減：咳嗽甚者加枇杷葉、浙貝母。
Addition and subtraction: cough worse add loquat leaf, Zhejiang fritillaria.
中成藥：可選擇疏風解毒膠囊、連花清瘟膠囊、清開靈注射液。
Proprietary Chinese medicine: can choose Shufengjiedu capsule, Lianhua Qingwen capsule, Qingkailing injection.
2.疫毒壅肺，內(nèi)閉外脫
The 2 epidemic disease in the lung, unconsciousness and collapse
癥狀：高熱，咳嗽，痰少難咯，憋氣，喘促，咯血，四末不溫，冷汗淋漓，躁擾不安，甚則神昏譫語。
Symptoms: fever, cough, sputum less difficult to argue, shortness of breath, dyspnea, hemoptysis, four end not warm, cold sweat, manic disturbed, even Shenhun delirium.
治法：清肺解毒，扶正固脫
Treatment: the Qingfei detoxification, strengthening the body resistance
參考處方：
Reference prescription:
炙麻黃 炒杏仁 生石膏 知母 魚腥草 黃芩
Chinese ephedra Chao Xingren gypsum Anemarrhena Houttuynia Scutellaria
炒梔子 虎杖 山萸肉 太子參
Fried Gardenia Polygonum cuspidatum Cornus heterophylla
水煎服，每日1—2劑，每4—6小時口服或鼻飼一次。
Shuijianbi, daily 1 - 2, every 4 - 6 hours of oral or nasal feeding time.
加減：高熱、神志恍惚、甚至神昏譫語者，上方送服安宮牛黃丸;肢冷、汗出淋漓者加人參、炮附子、煅龍骨、煅牡蠣;咯血者加赤芍、仙鶴草、側(cè)柏葉;口唇紫紺者加三七、益母草、黃芪、當歸尾。
Addition and subtraction: high fever, trance, and even coma, above take of Angong Niuhuang Pill; cold limbs, sweating profusely with ginseng, Cyperus rotundus, calcined keel, calcined oyster; hemoptysis and radix paeoniae rubra, agrimony, Oriental Arborvitae; cyanosis plus three seven, motherwort, astragalus, angelica tail.
中成藥：可選擇參麥注射液、生脈注射液。
Proprietary Chinese medicine: choice of Shenmai injection, Shengmai injection.
(五)加強支持治療和預防并發(fā)癥。注意休息、多飲水、增加營養(yǎng)，給易于消化的飲食。密切觀察，監(jiān)測并預防并發(fā)癥?？咕幬飸诿鞔_繼發(fā)細菌感染時或有充分證據(jù)提示繼發(fā)細菌感染時使用。
(five) to strengthen support for the treatment and prevention of complications. Pay attention to rest, more water, increase nutrition, to easily digestible diet. Close observation, monitoring and prevention of complications. Antimicrobial agents should be sufficient evidence of secondary bacterial infection in clear secondary bacterial infection or.
(六)重癥患者的治療。重癥患者應入院治療，對出現(xiàn)呼吸功能障礙者給予吸氧及其他相應呼吸支持，發(fā)生其它并發(fā)癥的患者應積極采取相應治療。
(six) in treatment of severe patients. Patients should be hospitalized, support oxygen and other relevant respiration to respiratory dysfunction, patients with other complications should actively take corresponding treatment.
1.呼吸功能支持：
1 respiratory support:
(1)機械通氣：重癥患者病情進展迅速，可較快發(fā)展為急性呼吸窘迫綜合征(ARDS)。在需要機械通氣的重癥病例，可參照ARDS機械通氣的原則進行。
(1) mechanical ventilation: the progression of severe patients rapidly, which can rapidly developed acute respiratory distress syndrome (ARDS). In need of mechanical ventilation in severe cases, can consult ARDS mechanical ventilation principle.
①無創(chuàng)正壓通氣：出現(xiàn)呼吸窘迫和(或)低氧血癥患者，早期可嘗試使用無創(chuàng)通氣。但重癥病例無創(chuàng)通氣療效欠佳，需及早考慮實施有創(chuàng)通氣。
The noninvasive positive pressure ventilation: respiratory distress and (or) hypoxemia in patients with early, can try to use noninvasive ventilation. But severe cases of noninvasive ventilation poor efficacy, they should consider implementing invasive mechanical ventilation.
②有創(chuàng)正壓通氣：鑒于部分患者較易發(fā)生氣壓傷，應當采用ARDS保護性通氣策略。
② invasive positive pressure ventilation: given that some patients are more prone to barotrauma, should adopt the ARDS protective ventilation strategies.
(2)體外膜氧合(ECMO)：傳統(tǒng)機械通氣無法維持滿意氧合和(或)通氣時，有條件時，推薦使用ECMO。
(2) the extracorporeal membrane oxygenation (ECMO): conventional mechanical ventilation is unable to maintain satisfactory oxygenation and (or) ventilation, conditional, recommend the use of ECMO.
(3)其他：傳統(tǒng)機械通氣無法維持滿意氧合時，可以考慮俯臥位通氣或高頻振蕩通氣(HFOV)。
(3) other: conventional mechanical ventilation is unable to maintain satisfactory oxygenation, can consider the prone position ventilation or high-frequency oscillatory ventilation (HFOV).
2.其他治療：在呼吸功能支持治療的同時，應當重視其他器官功能狀態(tài)的監(jiān)測及治療;預防并及時治療各種并發(fā)癥尤其是醫(yī)院獲得性感染。
2 other treatment: in the respiratory support therapy at the same time, should pay attention to monitoring and treatment of other organs of state; prevention and timely treatment of complications especially hospital acquired infection.
六、其它
Six, other
嚴格規(guī)范收治人感染H7N9禽流感患者醫(yī)療機構(gòu)的醫(yī)院感染控制措施。遵照標準預防的原則，根據(jù)疾病傳播途徑采取防控措施。具體措施依據(jù)《人感染H7N9禽流感醫(yī)院感染預防與控制技術(shù)指南(2013年版)》的相關(guān)規(guī)定。
Strictly regulate the patients medical H7N9 avian influenza were hospital infection control measures. In accordance with the standards of the precautionary principle, control measures according to the disease transmission. "Specific measures on the basis of human infection with the H7N9 avian influenza prevention and control of hospital infection technical guide (2013 Edition)" the relevant provisions.
看完了以上的措施和規(guī)定，不知你是否已經(jīng)明白了呢?快去告訴身邊的人吧，預防禽流感，人人有責!
After reading the above measures and regulations, I do not know whether you understand? Go and tell the people around it, to prevent bird flu, is everyone's responsibility!
H7N9來勢洶洶，人感染H7N9禽流感是由H7N9亞型禽流感病毒引起的急性呼吸道傳染病?，F(xiàn)在我們需要了解H7N9的根本然后來做出相對應的預防措施，下面讓我們來了解一下吧。
H7N9 break in in full fury, human infection with the H7N9 avian influenza is an acute respiratory tract caused by avian influenza H7N9 virus infection. Now we need to understand the H7N9 fundamental and then make the corresponding preventive measures, let us to know about it.
一、病原學
A, etiology
禽流感病毒屬正粘病毒科甲型流感病毒屬。禽甲型流感病毒顆粒呈多形性，其中球形直徑80～120nm，有囊膜。基因組為分節(jié)段單股負鏈RNA。依據(jù)其外膜血凝素(H)和神經(jīng)氨酸酶(N)蛋白抗原性不同，目前可分為16個H亞型(H1～H16)和9個N亞型(N1～N9)。禽甲型流感病毒除感染禽外，還可感染人、豬、馬、水貂和海洋哺乳動物?？筛腥救说那萘鞲胁《緛喰蜑镠5N1、H9N2、H7N7、H7N2、H7N3，此次報道的為人感染H7N9禽流感病毒。該病毒為新型重配病毒，其內(nèi)部基因來自于H9N2禽流感病毒。
Avian influenza virus belonging to Orthomyxoviridae influenza a virus. Avian influenza A virus particles were polymorphic, the spherical diameter of 80 ~ 120nm, capsule. Genome is segmented negative-stranded RNA. On the basis of the outer membrane of hemagglutinin (H) and neuraminidase (N) proteins are antigenically different, can be divided into 16 subtypes of H (H1 to H16) and 9 N subtypes (N1 ~ N9). Avian influenza A virus in avian, can also be infected people, pigs, horses, mink and marine mammals. Infection of human avian influenza virus subtype H5N1, H9N2, H7N7, H7N2, H7N3, the reported human infection with the H7N9 avian influenza virus. This virus was a new reassortant virus, its internal genes from H9N2 avian influenza virus.
禽流感病毒普遍對熱敏感，對低溫抵抗力較強，65℃加熱30分鐘或煮沸(100℃)2分鐘以上可滅活。病毒在較低溫度糞便中可存活1周，在4℃水中可存活1個月，對酸性環(huán)境有一定抵抗力，在pH4.0的條件下也具有一定的存活能力。在有甘油存在的情況下可保持活力1年以上。
Avian influenza virus is sensitive to heat, strong resistance of low temperature, 65 ℃ for 30 minutes or boiling (100 ℃) for more than 2 minutes can be inactivated. The virus in the lower temperature in feces can survive for 1 weeks, in 4 ℃ water can survive for 1 months, have a certain resistance to the acidic environment, but also has a certain ability to survive under the conditions of pH4.0. In the presence of glycerol can keep the activity of 1 years.
二、流行病學
Two, epidemiology
(一)傳染源。目前尚不明確，根據(jù)以往經(jīng)驗及本次病例流行病學調(diào)查，推測可能為攜帶H7N9禽流感病毒的禽類及其分泌物或排泄物。
(a) the source of infection. It is not clear, according to a survey of past experience and the epidemiological, presumably to carry the H7N9 avian influenza virus in poultry and its secretion or excretion.
(二)傳播途徑。經(jīng)呼吸道傳播，也可通過密切接觸感染的禽類分泌物或排泄物等被感染，直接接觸病毒也可被感染。現(xiàn)尚無人與人之間傳播的確切證據(jù)。
(two) transmission. Spread through the respiratory tract, and also can be infected through close contact with infected birds secretion or excretion, direct contact with the virus can also be infected. There is no evidence of communication between now and the.
(三)易感人群。目前尚無確切證據(jù)顯示人類對H7N9禽流感病毒易感?，F(xiàn)有確診病例均為成人。
(three) the susceptible population. At present there is no conclusive evidence of human H7N9 avian influenza virus susceptibility. The confirmed cases were adult.
(四)高危人群 ?，F(xiàn)階段主要是從事禽類養(yǎng)殖、銷售、宰殺、加工業(yè)者，以及在發(fā)病前1周內(nèi)接觸過禽類者。
(four) high risk population. At the present stage is mainly engaged in poultry breeding, slaughter, processing, sales, as well as in the 1 week prior to the onset of contact with poultry.
三、臨床表現(xiàn)
Three, clinical manifestation
根據(jù)流感的潛伏期及現(xiàn)有H7N9禽流感病毒感染病例的調(diào)查結(jié)果，潛伏期一般為7天以內(nèi)。
Based on the results of the investigation during the incubation period and the existing H7N9 avian influenza virus infection, incubation period is generally 7 days.
(一) 一般表現(xiàn)。
(a) the general performance.
患者一般表現(xiàn)為流感樣癥狀，如發(fā)熱，咳嗽，少痰，可伴有頭痛、肌肉酸痛和全身不適。重癥患者病情發(fā)展迅速，表現(xiàn)為重癥肺炎，體溫大多持續(xù)在39℃以上，出現(xiàn)呼吸困難，可伴有咯血痰;可快速進展出現(xiàn)急性呼吸窘迫綜合征、縱隔氣腫、膿毒癥、休克、意識障礙及急性腎損傷等。
Patients typically present with flu-like symptoms, such as fever, cough, less sputum, accompanied by headache, muscle pain and malaise. Patients with severe illness development is rapid, manifested as severe pneumonia, mostly persistent temperature over 39 ℃, difficulty in breathing, may be accompanied by hemoptysis sputum; rapid progress in acute respiratory distress syndrome, mediastinal emphysema, sepsis, shock, disturbance of consciousness and acute kidney injury.
(二)實驗室檢查。
(two) laboratory.
1.血常規(guī)。白細胞總數(shù)一般不高或降低。重癥患者多有白細胞總數(shù)及淋巴細胞減少，并有血小板降低。
1 blood. Total white cell count in general is not high or lower. Many patients with severe and the total number of lymphocytes decreased white blood cells, and platelets.
2.血生化檢查。多有肌酸激酶、乳酸脫氫酶、天門冬氨酸氨基轉(zhuǎn)移酶、丙氨酸氨基轉(zhuǎn)移酶升高，C反應蛋白升高，肌紅蛋白可升高。
2 blood biochemical examination. There are many creatine kinase, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase elevated C, elevated C-reactive protein, myoglobin can increase.
3.病原學檢測。
Study 3 pathogen detection.
(1)核酸檢測。對患者呼吸道標本(如鼻咽分泌物、口腔含漱液、氣管吸出物或呼吸道上皮細胞)采用real time PCR(或RT-PCR)檢測到H7N9禽流感病毒核酸。
(1) nucleic acid detection. In patients with respiratory specimens (such as nasopharyngeal secretions, oral gargle, tracheal aspirate or respiratory epithelial cells) using real time PCR (or RT-PCR) to the H7N9 avian influenza virus nucleic acid detection.
(2)病毒分離。從患者呼吸道標本中分離H7N9禽流感病毒。
(2) virus isolation. The separation of H7N9 avian influenza virus from patients with respiratory tract specimens.
(三)胸部影像學檢查。發(fā)生肺炎的患者肺內(nèi)出現(xiàn)片狀影像。重癥患者病變進展迅速，呈雙肺多發(fā)磨玻璃影及肺實變影像，可合并少量胸腔積液。發(fā)生ARDS時，病變分布廣泛。
(three) the chest imaging. Pneumonia patients of lung lamellar image. In patients with severe lesions rapidly, a double multiple pulmonary ground-glass opacity and consolidation of lung image, with a small amount of pleural effusion. The occurrence of ARDS, lesions are widely distributed.
(四)預后。人感染H7N9禽流感重癥患者預后差。影響預后的因素可能包括患者年齡、基礎(chǔ)疾病、合并癥等。
(four) the prognosis. Of human infection with H7N9 avian influenza patients with poor prognosis. Prognostic factors may include patient age, underlying diseases, complications.
四、診斷與鑒別診斷
Four, diagnosis and differential diagnosis
(一)診斷。根據(jù)流行病學接觸史、臨床表現(xiàn)及實驗室檢查結(jié)果，可作出人感染H7N9禽流感的診斷。在流行病學史不詳?shù)那闆r下，根據(jù)臨床表現(xiàn)、輔助檢查和實驗室檢測結(jié)果，特別是從患者呼吸道分泌物標本中分離出H7N9禽流感病毒，或H7N9禽流感病毒核酸檢測陽性，可以診斷。
(a) diagnosis. According to the epidemiological contact history, clinical manifestations and laboratory test results, can make the diagnosis of human infection with the H7N9 avian influenza. In the history of epidemiology of unknown circumstances, according to the detection results of clinical manifestation, auxiliary examination and laboratory, especially H7N9 avian influenza viruses isolated from patients with respiratory tract secretion samples, or nucleic acid of H7N9 avian influenza virus detection, diagnosis.
1.流行病學史。發(fā)病前1周內(nèi)與禽類及其分泌物、排泄物等有接觸史。
1 epidemiological history. 1 week prior to the onset of poultry and its secretion and excretion, contact history.
2.診斷標準。
2 diagnostic standards.
(1)疑似病例：符合上述臨床癥狀及血常規(guī)、生化及胸部影像學特征，甲型流感病毒通用引物陽性并排除了季節(jié)性流感，可以有流行病學接觸史。
(1) cases of suspected: meet the characteristics of the clinical symptoms and blood routine, biochemical and imaging of the chest, influenza virus a universal primer positive and eliminate the seasonal flu, can have the epidemiological contact history.
(2)確診病例：符合疑似病例診斷標準，并且呼吸道分泌物標本中分離出H7N9禽流感病毒或H7N9禽流感病毒核酸檢測陽性。
(2) cases with suspected cases: diagnostic criteria, and respiratory secretion were isolated from H7N9 avian influenza virus or avian H7N9 influenza virus nucleic acid detection positive.
重癥病例：肺炎合并呼吸功能衰竭或其他器官功能衰竭者為重癥病例。
Severe cases: pneumonia complicated with respiratory failure or other organ failure in severe cases.
(二)鑒別診斷。應注意與人感染高致病性H5N1禽流感、季節(jié)性流感(含甲型H1N1流感)、細菌性肺炎、傳染性非典型肺炎(SARS)、新型冠狀病毒肺炎、腺病毒肺炎、衣原體肺炎、支原體肺炎等疾病進行鑒別診斷。鑒別診斷主要依靠病原學檢查。
(two) the differential diagnosis. Attention should be paid to the highly pathogenic H5N1 avian influenza, seasonal flu and human infection (including the influenza a H1N1 influenza), bacterial pneumonia, infectious atypical pneumonia (SARS), a novel coronavirus pneumonia disease, adenovirus pneumonia, Chlamydia pneumoniae, mycoplasma pneumonia, differential diagnosis. Differential diagnosis should mainly rely on the etiological examination.
五、治療
Five, treatment
(一)對臨床診斷和確診患者應進行隔離治療。
(a) for clinical diagnosis and diagnosed patients should be treated in isolation.
(二)對癥治療?？晌酢媒鉄崴?、止咳祛痰藥等。
(two) for symptomatic treatment. Application of oxygen, can be antipyretic, cough expectorant.
(三)抗病毒治療。應盡早應用抗流感病毒藥物。
(three) antiviral treatment. Early application of antiviral drugs.
1.神經(jīng)氨酸酶抑制劑：可選用奧司他韋(Oseltamivir)或扎那米韋(Zanamivir)，臨床應用表明對禽流感病毒H5N1和H1N1感染等有效，推測對人感染H7N9禽流感病毒應有效。奧司他韋成人劑量75mg每日兩次，重癥者劑量可加倍，療程5-7天。扎那米韋成人劑量10mg，每日兩次吸入。
1 neuraminidase inhibitors: use oseltamivir or zanamivir (Oseltamivir) (Zanamivir), clinical application shows that effective against avian influenza virus H5N1 and H1N1 infection, speculated that the effective of human infection with the H7N9 avian influenza virus. Oseltamivir adult dose of 75mg two times a day, severe dose may be doubled, treatment 5-7 days. Zana Mi Vee adult dose 10mg, two times daily intake.
2.離子通道M2阻滯劑：目前實驗室資料提示金剛烷胺(Amantadine)和金剛乙胺(Rimantadine)耐藥，不建議單獨使用。
2 M2 ion channel blocker: the laboratory data suggest that amantadine and rimantadine (Amantadine) (Rimantadine) resistance, is not recommended to use alone.
(四)中醫(yī)藥治療。
(four) treated with traditional Chinese medicine.
1.疫毒犯肺，肺失宣降
1 disease drug lung, lung loses Xuan drop
癥狀：發(fā)熱，咳嗽，少痰，頭痛，肌肉關(guān)節(jié)疼痛。
Symptoms: fever, cough, less sputum, headache, muscle and joint pain.
治法：清熱宣肺
Method: heat Xuanfei
參考處方：
Reference prescription:
桑葉 金銀花 連翹 炒杏仁 生石膏 知母 蘆根 青蒿 黃芩 生甘草
Mulberry leaf honeysuckle and Forsythia Chao Xingren Anemarrhenae Rhizoma Phragmitis gypsum Artemisia Scutellaria Radix Glycyrrhizae
水煎服，每日1—2劑，每4—6小時口服一次。
Shuijianbi, daily 1 - 2, every 4 - 6 hours once oral.
加減：咳嗽甚者加枇杷葉、浙貝母。
Addition and subtraction: cough worse add loquat leaf, Zhejiang fritillaria.
中成藥：可選擇疏風解毒膠囊、連花清瘟膠囊、清開靈注射液。
Proprietary Chinese medicine: can choose Shufengjiedu capsule, Lianhua Qingwen capsule, Qingkailing injection.
2.疫毒壅肺，內(nèi)閉外脫
The 2 epidemic disease in the lung, unconsciousness and collapse
癥狀：高熱，咳嗽，痰少難咯，憋氣，喘促，咯血，四末不溫，冷汗淋漓，躁擾不安，甚則神昏譫語。
Symptoms: fever, cough, sputum less difficult to argue, shortness of breath, dyspnea, hemoptysis, four end not warm, cold sweat, manic disturbed, even Shenhun delirium.
治法：清肺解毒，扶正固脫
Treatment: the Qingfei detoxification, strengthening the body resistance
參考處方：
Reference prescription:
炙麻黃 炒杏仁 生石膏 知母 魚腥草 黃芩
Chinese ephedra Chao Xingren gypsum Anemarrhena Houttuynia Scutellaria
炒梔子 虎杖 山萸肉 太子參
Fried Gardenia Polygonum cuspidatum Cornus heterophylla
水煎服，每日1—2劑，每4—6小時口服或鼻飼一次。
Shuijianbi, daily 1 - 2, every 4 - 6 hours of oral or nasal feeding time.
加減：高熱、神志恍惚、甚至神昏譫語者，上方送服安宮牛黃丸;肢冷、汗出淋漓者加人參、炮附子、煅龍骨、煅牡蠣;咯血者加赤芍、仙鶴草、側(cè)柏葉;口唇紫紺者加三七、益母草、黃芪、當歸尾。
Addition and subtraction: high fever, trance, and even coma, above take of Angong Niuhuang Pill; cold limbs, sweating profusely with ginseng, Cyperus rotundus, calcined keel, calcined oyster; hemoptysis and radix paeoniae rubra, agrimony, Oriental Arborvitae; cyanosis plus three seven, motherwort, astragalus, angelica tail.
中成藥：可選擇參麥注射液、生脈注射液。
Proprietary Chinese medicine: choice of Shenmai injection, Shengmai injection.
(五)加強支持治療和預防并發(fā)癥。注意休息、多飲水、增加營養(yǎng)，給易于消化的飲食。密切觀察，監(jiān)測并預防并發(fā)癥?？咕幬飸诿鞔_繼發(fā)細菌感染時或有充分證據(jù)提示繼發(fā)細菌感染時使用。
(five) to strengthen support for the treatment and prevention of complications. Pay attention to rest, more water, increase nutrition, to easily digestible diet. Close observation, monitoring and prevention of complications. Antimicrobial agents should be sufficient evidence of secondary bacterial infection in clear secondary bacterial infection or.
(六)重癥患者的治療。重癥患者應入院治療，對出現(xiàn)呼吸功能障礙者給予吸氧及其他相應呼吸支持，發(fā)生其它并發(fā)癥的患者應積極采取相應治療。
(six) in treatment of severe patients. Patients should be hospitalized, support oxygen and other relevant respiration to respiratory dysfunction, patients with other complications should actively take corresponding treatment.
1.呼吸功能支持：
1 respiratory support:
(1)機械通氣：重癥患者病情進展迅速，可較快發(fā)展為急性呼吸窘迫綜合征(ARDS)。在需要機械通氣的重癥病例，可參照ARDS機械通氣的原則進行。
(1) mechanical ventilation: the progression of severe patients rapidly, which can rapidly developed acute respiratory distress syndrome (ARDS). In need of mechanical ventilation in severe cases, can consult ARDS mechanical ventilation principle.
①無創(chuàng)正壓通氣：出現(xiàn)呼吸窘迫和(或)低氧血癥患者，早期可嘗試使用無創(chuàng)通氣。但重癥病例無創(chuàng)通氣療效欠佳，需及早考慮實施有創(chuàng)通氣。
The noninvasive positive pressure ventilation: respiratory distress and (or) hypoxemia in patients with early, can try to use noninvasive ventilation. But severe cases of noninvasive ventilation poor efficacy, they should consider implementing invasive mechanical ventilation.
②有創(chuàng)正壓通氣：鑒于部分患者較易發(fā)生氣壓傷，應當采用ARDS保護性通氣策略。
② invasive positive pressure ventilation: given that some patients are more prone to barotrauma, should adopt the ARDS protective ventilation strategies.
(2)體外膜氧合(ECMO)：傳統(tǒng)機械通氣無法維持滿意氧合和(或)通氣時，有條件時，推薦使用ECMO。
(2) the extracorporeal membrane oxygenation (ECMO): conventional mechanical ventilation is unable to maintain satisfactory oxygenation and (or) ventilation, conditional, recommend the use of ECMO.
(3)其他：傳統(tǒng)機械通氣無法維持滿意氧合時，可以考慮俯臥位通氣或高頻振蕩通氣(HFOV)。
(3) other: conventional mechanical ventilation is unable to maintain satisfactory oxygenation, can consider the prone position ventilation or high-frequency oscillatory ventilation (HFOV).
2.其他治療：在呼吸功能支持治療的同時，應當重視其他器官功能狀態(tài)的監(jiān)測及治療;預防并及時治療各種并發(fā)癥尤其是醫(yī)院獲得性感染。
2 other treatment: in the respiratory support therapy at the same time, should pay attention to monitoring and treatment of other organs of state; prevention and timely treatment of complications especially hospital acquired infection.
六、其它
Six, other
嚴格規(guī)范收治人感染H7N9禽流感患者醫(yī)療機構(gòu)的醫(yī)院感染控制措施。遵照標準預防的原則，根據(jù)疾病傳播途徑采取防控措施。具體措施依據(jù)《人感染H7N9禽流感醫(yī)院感染預防與控制技術(shù)指南(2013年版)》的相關(guān)規(guī)定。
Strictly regulate the patients medical H7N9 avian influenza were hospital infection control measures. In accordance with the standards of the precautionary principle, control measures according to the disease transmission. "Specific measures on the basis of human infection with the H7N9 avian influenza prevention and control of hospital infection technical guide (2013 Edition)" the relevant provisions.
看完了以上的措施和規(guī)定，不知你是否已經(jīng)明白了呢?快去告訴身邊的人吧，預防禽流感，人人有責!
After reading the above measures and regulations, I do not know whether you understand? Go and tell the people around it, to prevent bird flu, is everyone's responsibility!