Chinese medicine treatment of H1N1 latest package
Posted on November 7, 2009
Filed Under H1N1 Treatment & Drugs | Leave a Comment
In March 2009, Mexico outbreak, “people are infected with swine flu” epidemic and rapidly spreading worldwide. World Health Organization (WHO) this initial influenza known as the “people are infected with swine flu”, will be renamed to “Influenza A H1N1 influenza.” June 11, WHO announced that it would Influenza A H1N1 influenza pandemic warning level upgraded to 6, the global access to influenza pandemic phase. The flu is a new type of respiratory diseases, their pathogenic H1N1 influenza virus as a new strain of influenza A virus genome contains swine flu, avian flu and human influenza three kinds of influenza virus gene fragments.
The treatment program is the second edition of July 10 on the basis of treatment programs, according to recent research results at home and abroad and China’s experience of Influenza A H1N1 flu clinics are updated. Because of this Influenza A H1N1 Influenza is an emerging disease, the law of their disease remains to be further observation and study.
I. Etiology
Influenza A H1N1 influenza virus belongs to Orthomyxoviruses Branch (0rthomyxoviridae), influenza virus (Influenza virus A). A typical virus particle was spherical with a diameter of 80nm ~ 120nm, with envelope. Many of the membrane sac arranged radially protruding glycoprotein, namely, red blood cell hemagglutinin (HA), neuraminidase (NA) and matrix protein M2. Nucleocapsid within the viral particles, showing helical symmetry, a diameter of 10nm. For the single-stranded minus-strand RNA virus genome of approximately 13.6kb, ranging from the size of the eight composed of separate fragments. Virus on ethanol, iodophor, iodine and other commonly used disinfectants sensitive; pairs of heat-sensitive, 56 ℃ under 30 minutes to inactivate.
Second, epidemiological
(A) The source of infection.
Influenza A H1N1 influenza patients as the main source of infection, asymptomatic infections are also contagious. There is no evidence of animals to humans.
(B) transmission.
Mainly through droplets spread through the respiratory tract, but also through the mouth, nose, eyes, mucous membranes, etc., directly or indirectly, contact. Contact with respiratory secretions, body fluids and items contaminated by the virus may also cause infection. By aerosol spread through the respiratory tract remains to be further confirmed.
(C) susceptible populations.
Generally susceptible populations.
(D) become easy targets of severe cases of high-risk groups.
Influenza-like symptoms following the crowd, the easier development of severe cases, should be given high priority, as soon as possible influenza A H1N1 influenza virus nucleic acid testing and other necessary checks.
1. Pregnant women;
2. With the following diseases or conditions are: chronic respiratory disease, cardiovascular disease (except hypertension), kidney disease, liver disease, blood system diseases, nervous system and neuromuscular diseases, metabolic and endocrine system diseases, immune suppression (including the application of immunosuppressive agents or HIV infection-induced immune dysfunction), 19 persons under the age of long-term aspirin;
3. Obese persons (body mass index ≥ 40 high-risk, body mass index may be risk factors in 30-39);
4. Age “5 year-old children (aged” two years of age are prone to serious complications);
5. Aged ≥ 65 years of age.
3, clinical manifestations and laboratory examinations
The incubation period is generally 1 to 7 days, more than 1 to 3 days.
(A) the clinical manifestations.
Usually presents flu-like symptoms, including fever, sore throat, runny nose, stuffy nose, cough, expectoration, headache, body aches, fatigue. Some cases of vomiting and / or diarrhea. Only a small number of cases of mild upper respiratory symptoms, no fever. Signs include swelling of the throat and tonsil congestion.
Complications such as pneumonia can occur. A few cases, the rapid progress of the disease, respiratory failure, multiple organ dysfunction or failure.
May induce aggravation of the original underlying diseases, showing the corresponding clinical manifestations.
Serious condition can lead to death.
(B) laboratory tests.
1. Peripheral blood examination: WBC count was not normally high or lower.
2. Blood biochemical tests: Some cases are hypokalemia, a small number of cases of creatine kinase, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase increased.
3. Pathogen check:
(1) The virus nucleic acid testing: the RT-PCR (preferably in real-time RT-PCR) to detect respiratory tract specimens (throat swab, nasal swab, nasopharyngeal or tracheal Abstraction, sputum) in the Influenza A H1N1 influenza viral nucleic acid, results can be positive.
(2) virus isolation: respiratory specimens out of Influenza A H1N1 influenza virus separable.
(3) serum antibody test: dynamic detection of double Influenza H1N1 influenza virus-specific serum antibody level was four times or four times higher.
(C) chest imaging examination.
When combined with pneumonia lung shadows visible sheet.
IV diagnosis
Diagnosis is primarily with epidemiological history, clinical manifestations and pathology examination, early detection, early diagnosis is the key to the prevention and control and effective treatment.
(A) the suspected case.
One of the following conditions can be diagnosed as suspected cases:
1. Within 7 days prior to the onset period of Influenza A H1N1 infection have close contact with confirmed cases of influenza and influenza-like clinical manifestations.
Close contact is defined as failure to take effective protection cases, treatment, care of infectious period of the Influenza A H1N1 influenza patients; with the patient to live together; contact with respiratory secretions, body fluids and so on.
2. Within 7 days prior to the onset have been to Influenza A H1N1 influenza pandemic (a virus of the continuing level of human communication and community-based prevalence and outbreaks) areas, the incidence of influenza-like clinical manifestations.
3. Influenza-like clinical manifestations, positive for influenza virus detection, virus subtype has not yet further tests.
The above-mentioned three kinds of circumstances, in the conditions permit, it can be arranged pathogenic influenza A H1N1 influenza inspection.
(B) clinical diagnosis of cases.
Is limited to the following clinical circumstances: Same as with the outbreak of Influenza A H1N1 influenza without laboratory-confirmed cases of influenza-like symptoms, in the exclusion of other diseases caused by influenza-like symptoms can be diagnosed as clinically diagnosed case.
Influenza A H1N1 influenza outbreak is a region or unit short-term abnormal number of influenza-like illness, after laboratory tests identified as Influenza A H1N1 influenza outbreak.
In the conditions allow, the clinical diagnosis of pathogenic examination of cases can be arranged.
(C) confirmed cases.
Influenza-like clinical manifestations, while one or more of the following laboratory results:
1. Influenza A H1N1 influenza virus nucleic acid testing positive (can use real-time RT-PCR and RT-PCR method);
2. Isolated from influenza A H1N1 influenza virus;
3. Double serum Influenza H1N1 influenza virus-specific antibody levels was four times or four times higher.
5, severe and critical illness
(A) one of the following conditions for the severe cases:
1. Continued high fever “3 days;
2. Severe cough, cough Nong Tan, blood sputum, or chest pain;
3. Respiration rate fast, difficulty breathing, lips cyanosis;
4. Consciousness change: slow, drowsiness, restlessness, convulsions, etc.;
5. Severe vomiting, diarrhea, dehydration performance;
6. Imaging examination signs of pneumonia;
7. Creatine kinase (CK), creatine kinase isoenzyme (CK-MB) and so on myocardial enzyme level increased rapidly;
8. The original basis of the disease increased significantly.
(B) one of the following conditions for the critical cases:
1. Respiratory failure;
2. Infected with toxic shock;
3. Multiple organ dysfunction;
4. There would be other in need of care treatment for serious clinical condition.
6, the clinical classification treatment guidelines
(A) Suspected cases: In the well-ventilated room with a separate isolation. Inpatients to be done pathogenic Influenza A H1N1 influenza inspection.
(B) clinical diagnosis of cases: well-ventilated room with a separate isolation. Inpatients to be done pathogenic Influenza A H1N1 influenza inspection.
(C) confirmed cases: well-ventilated isolation rooms. Hospitalized cases can be more than in the same room.
7, hospitalization principles
According to local medical resources in patients with the condition and status, in accordance with the principle of priority arrangements for severe hospitalized.
(A) Priority admitted to hospital with severe and critical cases. Pairs of critical cases, according to local medical facilities conditions, the timely prevention and control of the conditions of transfer with severe Medicine (ICU) treatment.
(B) does not have the severe and critical cases where the conditions of medical institutions, in ensuring the safety of medical care under the premise of cases should be promptly transferred to the conditions of the hospital; condition not suitable for referral, the local health administrative departments or higher-level health administrative departments Experts should be organized locally active treatment.
(C) the high-risk groups to become more easily infected with influenza A H1N1 influenza cases of severe disease are advised to arrange hospital treatment. Such as the implementation of home quarantine for treatment, should closely monitor the patient’s condition deteriorated when there is timely diagnosis and treatment arrangements for hospitalization.
(D) Mild cases can be arranged for home quarantine for observation and treatment.
8, treatment
(A) general treatment.
Rest, more water, close observation of condition changes; fever cases may be given to the cooling treatment.
(B) anti-viral treatment.
Studies have shown that such pairs of influenza A H1N1 influenza virus neuraminidase inhibitors currently oseltamivir (oseltamivir), zanamivir (zanamivir) sensitivity, resistance to amantadine and rimantadine.
For the clinical symptoms of mild and without complications, the condition tends to self-limited influenza A H1N1 influenza cases, without the positive application of neuraminidase inhibitors.
For when the disease that is a serious condition, after the onset of dynamic condition was deteriorating cases, infected with influenza A H1N1 influenza high-risk groups should be timely and the neuraminidase inhibitors for antiviral therapy. Start delivery time should be as much as possible within 48 hours of the onset of illness (in 36 hours of the best). For severe cases easier to become a high-risk groups, the event of a flu-like symptoms, not necessarily waiting for the virus nucleic acid test results, you can start antiviral therapy. Pregnant women after the influenza-like symptoms are advised as soon as possible to give the neuraminidase inhibitors.
Oseltamivir: Adult dosage of 75mg bid, treatment for 5 days. For the critically ill or in severe cases, doses of oseltamivir may exercise discretion to be increased to 150mg bid. For protracted illness cases, medication may be appropriate to extend the time. 1 year old and older pediatric patients should be administered according to the weight: 15kg underweight persons, to 30mg bid; weight of 15 ~ 23kg who I 45mg bid; weight of 23 ~ 40kg who I 60mg bid; body weight greater than 40kg who I 75mg bid. For children who have difficulty swallowing capsules may make use of oseltamivir suspension.
Zanamivir: For adults and children over 7 years of age. Adult dosage of 10mg inhalation bid, treatment for 5 days. Children over 7 years of age and usage with adults.
(C) other treatment.
1. In case of hypoxemia or respiratory failure, should promptly be given appropriate treatment measures, including oxygen therapy or mechanical ventilation and so on.
2. Combined with shock give the corresponding anti-shock therapy.
3. There would be other organ damage, giving the corresponding support treatment.
4. The merger of bacteria and / or fungal infection, giving the corresponding anti-bacterial and / or antifungal treatment.
5. For the severe and critical cases, you can also consider the use of Influenza A H1N1 influenza patients recovering from recent vaccination are immune plasma or plasma treatment.
Within 1 week of the onset of severe and critical cases, the premise of ensuring the health safety, the appropriate early use. Recommended Usage: General Adult 100 ~ 200ml, child 50ml (or on the basis of plasma antibody titers to adjust dosage), intravenous. If necessary, can be reused. The use of the process, attention to allergic reactions.
(D) TCM treatment.
Mild Differential Treatment Program
1. Wind-heat guilty Wei
Main symptoms: early onset, fever or fever, red throat discomfort, Qing Ke little sputum, sweat-free.
Lingual vein: tongue red, thin, or thin greasy moss, pulse a few floating.
Governing law: Shufeng heat
Basic Recipe: Silver Flower 15g Forsythia 15g mulberry 10g Hangzhou chrysanthemum 10g Campanulaceae 10g Arctiin 6g bamboo reed rhizome 30g Mint 15g (post under) 3g Health licorice 3g
Jianfu law: Shuijianbi, each dose of decoction 400 ml, 200 ml each time orally, 1, 2 times; if necessary, serve two days, every 6 hours orally 1 times, each time 200 ml.
Modified: moss-thick greasy plus patchouli, Perrin; cough re-Almond, loquat; diarrhea Kagawa berberine, Kwong costas; sore throat and heavier Kam lanterns.
Commonly used Chinese medicine: Chinese medicine, such as wind-dispersing type Shufeng heat detoxification capsules, Xiangju capsules, Yinqiaojiedu class, Sang Ju cold category, Shuanghuanglian class of oral agents; Huo Xiang Zheng Qi, class preparation, etc. Gegenqinlian.
2. Heat-toxin attack lung
Main symptoms: high fever, cough, sputum expectoration sticky bad mood, thirst-hi drink, sore throat, Mu Chi.
Lingual vein: tongue red, yellow or greasy moss, pulse a few slippery.
Governing law: Qingfei Detoxification
Basic Recipe: Sunburn ephedra 3g Health licorice 10g almonds 10g Gypsum (Xian Jian) 30g Zhimu 10g Zhejiang Fritillaria 10g Campanulaceae 15g skullcap 15g Chai Hu 15g
Jianfu law: Shuijianbi, each dose of decoction 400 ml, 200 ml each time orally, 1, 2 times; if necessary, serve two days, every 6 hours orally 1 times, each time 200 ml.
Modified: constipation Add rhubarb; sustained high fever plus Artemisia annua, paeonol.
Commonly used Chinese medicine: Chinese medicine, such as with Qingfei antidote to spend Qingwen capsule, silver yellow class preparation, class preparation, etc. Lotus heat.
Differential Treatment of Severe and Critical Care Program
1. Heat-toxin obstruct pulmonary
Main symptoms: high fever, cough, expectoration, sputum yellow, Chuancu shortness of breath; or palpitations, impatient interference disturbed dark purple lips.
Lingual vein: tongue red, greasy yellow, or gray greasy moss, pulse a few slippery.
Governing law: heat Xiefei, detoxification Sanyu
Basic Recipe: Sunburn ephedra 3g Health licorice 10g almonds 10g Gypsum (Xian Jian) 30g Zhimu 10g Zhejiang Fritillaria 10g Campanulaceae 15g skullcap 15g Chai Hu 15g
Jianfu law: Shuijianbi, each dose of decoction 400 ml, 200 ml each time orally, 1, 2 times; if necessary, serve two days, every 6 hours orally 1 times, each time 200 ml.
Modified: Continuous high fever, delirium Shenhun plus Angongniuhuang Pill; convulsions plus antelope horn, and silkworm, wide land dragon, etc.; bloating would knot plus citrus aurantium, sodium sulphate.
Commonly used Chinese medicine: Hei Yan-ping, Tanreqing Qing Kai Ling Injection.
2. Gas Burnt Camp 2
Main symptoms: high fever, thirst, irritability, Shenzheshenhun delirium, cough or hemoptysis, chest tightness, shortness of breath, hold your breath.
Lingual vein: tongue red purple-red, yellow moss, pulse breakdown.
Governing law: clear air cooler Camp
Basic Recipe: buffalo horn 30g habitat 15g red peony 10g Silver Flower 15g Salvia 12g forsythia 15g Ophiopogon 10g bamboo 6g Trichosanthes 30g Gypsum (Xian Jian) 30g Gardenia 12g
Jianfu law: Shuijianbi, each dose of decoction 400 ml, 200 ml each time orally, 1, 2 times; if necessary, serve two days, every 6 hours orally 1 times, each time 200 ml.
Modified: constipation plus rhubarb; febrile seizures plus antelope horn powder body.
Commonly used Chinese patent medicines: Angongniuhuang Pill, blood must be net, XNJI so.
Note: The above drugs should be used under the guidance of the physician; dose for reference, children’s doses reduce it; have complications, patients with a history of chronic basis, with the certificate administering treatment. See if the shock, multiple organ dysfunction syndrome, or associated with other serious illnesses who, in the application of Western medicine treatment, while administering treatment based on the actual situation with the card.
9, discharge standards
1. Temperature is normal 3 days, other flu-like symptoms disappeared, clinical stable condition can be discharged.
2. Due to underlying diseases or complications are serious, take longer time to hospitalization for influenza A H1N1 influenza cases, influenza A H1N1 influenza virus in throat swab DNA test turned negative, may go to the corresponding unit from the isolation ward for further treatment.
Comments
Leave a Reply