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目的总结埃博拉治疗中心(Ebola Treatment Unit,ETU)4级防护隔离条件下对疑似或可能埃博拉病毒病(EVD)患者进行医学观察和临床诊治的体会。方法选取2015年1月14至3月14日利比里亚中国ETU留观收治的32例疑似或可能EVD患者为研究对象,医生在4级个人防护隔离条件下查房,以询问病史为主要诊断疾病依据,给予双氢青蒿素哌喹片(3片,1次/d)、左氧氟沙星(0.5g,1次/d)、多维元素善存片(1片,1次/d)、口服补液盐Ⅲ(2包,3次/d)、全能营养素(40g,3次/d)为基础用药联合对症处理的经验性治疗。采用回顾性方法对患者流行病学史、临床症状及体征、诊断、治疗措施、疾病转归及不良反应等临床资料进行分析。结果 32例患者平均年龄(40.53±13.89)岁(14~83岁),男22例、女10例。发病后就诊时间中位数4.5(1~30)d。所有患者均有发热,平均最高体温(38.36±1.01)℃。主要伴随症状包括乏力25例(78.12%)、关节肌肉酸痛22例(68.75%)、恶心呕吐17例(53.12%)、头痛16例(50.00%)、食欲下降15例(46.88%)、腹泻14例(43.75%)、腹痛14例(43.75%)、咳嗽12例(37.50%)、胸痛10例(31.25%)、呼吸困难5例(15.62%)、吞咽困难4例(12.50%)、呃逆3例(9.38%)、消化道出血2例(6.25%)。32例患者平均住院时间(3.94±2.29)d。出院诊断包括急性胃肠炎13例,急性呼吸道感染7例,上消化道出血1例,腹水原因待查、肝癌可能1例,黄疸原因待查、肝炎可能1例,哮喘急性发作1例,疟疾1例,不完全性肠梗阻1例。26例好转出院,6例死亡,好转率81.25%(26/32)。体温恢复到正常者23例,平均发热恢复正常时间(3.51±1.60)d。患者未出现治疗无法耐受现象及严重不良反应。结论在ETU对疑似或可能EVD患者进行密切医学观察并熟练扎实地应用问诊、查体等医学基本功是诊断疾病的重要手段;经验性口服药物治疗联合对症处理安全、有效,具有一定的临床应用价值。
Objective To summarize the experience of medical observation and clinical diagnosis and treatment of patients with suspected or probable EVD in the Ebola Treatment Unit (ETU) under the condition of 4 levels of isolation. Methods Thirty-two patients with suspected or probable EVD admitted to the ETU in Liberia from January 14 to March 14, 2015 were enrolled in this study. The physicians conducted rounds of quarantine under grade 4 personal protection and isolation, (3 tablets, once a day), levofloxacin (0.5 g once a day), multidimensional tablets (1 tablet once daily), oral rehydration salt Ⅲ (2 packages, 3 times / d), all-round nutrients (40g, 3 times / d) as the basis of empirical treatment of symptomatic treatment. A retrospective analysis of the patient’s epidemiological history, clinical symptoms and signs, diagnosis, treatment measures, disease outcomes and adverse reactions and other clinical data were analyzed. Results The average age of 32 patients (40.53 ± 13.89) years (14 to 83 years), 22 males and 10 females. After the onset of treatment time median 4.5 (1 ~ 30) d. All patients had fever, the highest average body temperature (38.36 ± 1.01) ℃. The main accompanying symptoms included fatigue in 25 cases (78.12%), joint soreness in 22 cases (68.75%), nausea and vomiting in 17 cases (53.12%), headache in 16 cases (50.00%), loss of appetite in 15 cases (46.88%) and diarrhea (43.75%), abdominal pain 14 (43.75%), cough 12 (37.50%), chest pain 10 (31.25%), dyspnea 5 (15.62%), dysphagia 4 Cases (9.38%), gastrointestinal bleeding in 2 cases (6.25%). The average length of stay of 32 patients (3.94 ± 2.29) d. Discharge diagnosis included 13 cases of acute gastroenteritis, 7 cases of acute respiratory tract infection, 1 case of upper gastrointestinal bleeding, the cause of ascites pending examination, liver cancer in 1 case, the cause of jaundice to be investigated, hepatitis 1 case, acute asthma attack in 1 case, malaria 1 case, incomplete intestinal obstruction in 1 case. Twenty-six patients were discharged and 6 patients died. The improvement rate was 81.25% (26/32). The body temperature returned to normal in 23 cases, the average fever back to normal time (3.51 ± 1.60) d. Patients did not appear unable to tolerate the phenomenon and serious adverse reactions. Conclusions The ETU is an important means of diagnosing diseases in the ETU for the close medical observation of patients with suspected or possibly EVD and skilled and solid use of medical basic skills such as interrogation and physical examination. It is safe and effective that empirical oral medication treatment combined with symptomatic treatment has certain clinical application value.