歲月麻醉

Anesthesia,Joyful Life
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A型H1N1流感流行病學與系列病例報導





『台東市一名廿四歲男大學生,十三日感染新流感,昨天凌晨不治。這是國內第三例新流感死亡病例,也是發病至死亡時間最短的個案。

病發這八天中,台東基督教醫院、台東馬偕醫院篩檢都呈陰性,直到第七天,慈濟醫院才確認他得了新流感,隔天就過世了。……….』..........2009.8.21 聯合報



新流感的實驗室診斷:
國內三級以上實驗室檢測新型流感H1N1 檢驗方法有快速檢驗試劑(rapid test)、Real-time RT PCR 與病毒培養等。 快速檢驗試劑(rapid test)即利用L atex與特異性之A型病毒凝集法,檢驗迅速(rapid test) 在30-40 分鐘有結果,敏感性只有10~70%。
 美國CDC建議的處理流程,快速篩檢陰性,需要醫師依臨床資訊做綜合判斷,千萬不要掉以輕心。流程圖

個人將發病病程粗分為:
初期,發病無特異性,與一般感冒無法區別。1~3天。
中期,持續高燒不退(>39度C),4~5天
後期,急速惡化,呼吸窘迫或衰竭5~8天。

如何提高警覺心,以利早期介入治療,給予克流感呢?
抽血檢查,會發現白血球沒有增加,或減少,而淋巴球數目的多寡或影響預後,數目愈多,存活的機會愈大。另一個實驗室檢驗,LDH 或CK值,愈高,預後愈差。
New England Journal of Medicine 8/13出刊的文章:
Severe Respiratory Disease Concurrent with the Circulation of H1N1 Influenza

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