卫生部最新甲流诊疗方案

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<td class=txt01 align=middle>卫生部办公厅关于印发《甲型H1N1流感诊疗方案（2009年第三版）》的通知
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<td align=middle bgColor=#eeeeee><span class="">中华人民共和国卫生部&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 2009-10-13&nbsp;&nbsp;&nbsp;12:00:38 </span>
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<div><span lang=EN-US style="FONT-SIZE: 16pt; COLOR: white; FONT-FAMILY: 'Times New Roman'; mso-fareast-font-family: 仿宋_GB2312; mso-font-kerning: 1.0pt; mso-bidi-language: AR-SA; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN"><span style="mso-spacerun: yes">&nbsp; </span></span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 1.0pt; mso-bidi-language: AR-SA; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN; mso-hansi-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'">卫发明电〔</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 'Times New Roman'; mso-fareast-font-family: 仿宋_GB2312; mso-font-kerning: 1.0pt; mso-bidi-language: AR-SA; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN">2009</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 1.0pt; mso-bidi-language: AR-SA; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN; mso-hansi-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'">〕</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 'Times New Roman'; mso-fareast-font-family: 仿宋_GB2312; mso-font-kerning: 1.0pt; mso-bidi-language: AR-SA; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN">188</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 1.0pt; mso-bidi-language: AR-SA; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN; mso-hansi-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-ascii-font-family: 'Times New Roman'">号</span></div>
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<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312">各省、自治区、直辖市卫生厅局，新疆生产建设兵团卫生局：<span lang=EN-US><?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 12.0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">为有效应对甲型<span lang=EN-US>H1N1</span>流感流行，</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312">科学、规范、有效地开展医疗救治工作，由我部</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 12.0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">甲型<span lang=EN-US>H1N1</span>流感</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">临床专家组牵头，并委托中华医学会组织相关专家，结合我国</span><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-bidi-font-family: 宋体">甲型<span lang=EN-US>H1N1</span>流感实际诊疗经验，</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">借鉴世界卫生组织和其他国家、地区甲型</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312">H1N1</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">流感相关资料，</span><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-bidi-font-family: 宋体">对</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">《甲型</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312">H1N1</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">流感诊疗方案（</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312">2009</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">年试行版第二版）》</span><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-bidi-font-family: 宋体">进行了修订、完善，研究制定</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">了《甲型</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312">H1N1</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">流感诊疗方案（</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312">2009</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">年第三版）》。现印发给你们，供医疗机构在甲型</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312">H1N1</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">流感临床诊疗工作中使用。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" /><st1:chsdate Year="2009" Month="7" Day="10" IsLunarDate="False" IsROCDate="False" w:st="on"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312">2009</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">年</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312">7</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">月</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312">10</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">日</span></st1:chsdate><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">印发的《甲型</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312">H1N1</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">流感诊疗方案（</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312">2009</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">年试行版第二版）》（卫发明电〔</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312">2009</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">〕</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312">123</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 仿宋_GB2312">号）同时废止。</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312"><o:p></o:p></span></p>
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<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center" align=center><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312"><span style="mso-spacerun: yes">&nbsp;</span></span><b style="mso-bidi-font-weight: normal"><span lang=EN-US style="FONT-SIZE: 14pt; FONT-FAMILY: 宋体; mso-font-kerning: 0pt; mso-bidi-font-family: 宋体"><o:p></o:p></span></b></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center" align=center><b style="mso-bidi-font-weight: normal"><span style="FONT-SIZE: 22pt; FONT-FAMILY: 宋体; mso-font-kerning: 0pt; mso-bidi-font-family: 宋体">甲型<span lang=EN-US>H1N1</span>流感</span></b><b><span style="FONT-SIZE: 22pt; COLOR: black; FONT-FAMILY: 宋体; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-bidi-font-family: 宋体">诊疗方案<span lang=EN-US><o:p></o:p></span></span></b></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-ALIGN: center; mso-outline-level: 1" align=center><span style="FONT-SIZE: 14pt; FONT-FAMILY: 楷体_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">（<span lang=EN-US>2009</span>年第三版）<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><span lang=EN-US style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体"><o:p>&nbsp;</o:p></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32.25pt"><span lang=EN-US style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">2009</span><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">年<span lang=EN-US>3</span>月，墨西哥暴发“人感染猪流感”疫情，并迅速在全球范围内蔓延。世界卫生组织（<span lang=EN-US>WHO</span>）初始将此型流感称为“人感染猪流感”，后将其更名为“甲型<span lang=EN-US>H1N1</span>流感”。<span lang=EN-US>6</span>月<span lang=EN-US>11</span>日，<span lang=EN-US>WHO</span>宣布将甲型<span lang=EN-US>H1N1</span>流感大流行警告级别提升为<span lang=EN-US>6</span>级，全球进入流感大流行阶段。此次流感为一种新型呼吸道传染病，其病原为新甲型<span lang=EN-US>H1N1</span>流感病毒株，病毒基因中包含有猪流感、禽流感和人流感三种流感病毒的基因片段。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">本诊疗方案是在<st1:chsdate Year="2009" Month="7" Day="10" IsLunarDate="False" IsROCDate="False" w:st="on"><span lang=EN-US>7</span>月<span lang=EN-US>10</span>日</st1:chsdate>第二版诊疗方案基础上，依据近期国内外研究成果及我国甲型<span lang=EN-US>H1N1</span>流感诊疗经验修订而成。由于这种甲型<span lang=EN-US>H1N1</span>流感是一种新发疾病，其疾病规律仍待进一步观察和研究。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 黑体; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">一、病原学<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 40pt; mso-char-indent-count: 2.5"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">甲型<span lang=EN-US>H1N1</span>流感</span><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">病毒属于正粘病毒科（<span lang=EN-US>0rthomyxoviridae</span>），甲型流感病毒属（<span lang=EN-US>Influenza virus A</span>）。典型病毒颗粒呈球状，直径为<span lang=EN-US>80nm-120nm</span>，有囊膜。囊膜上有许多放射状排列的突起糖蛋白，分别是红细胞血凝素（<span lang=EN-US>HA</span>）、神经氨酸酶（<span lang=EN-US>NA</span>）和基质蛋白<span lang=EN-US>M2</span>。病毒颗粒内为核衣壳，呈螺旋状对称<span lang=EN-US>,</span>直径为<span lang=EN-US>10nm</span>。为单股负链<span lang=EN-US>RNA</span>病毒，基因组约为<span lang=EN-US>13.6kb</span>，由大小不等的<span lang=EN-US>8</span>个独立片段组成。病毒对乙醇、碘伏、碘酊等常用消毒剂敏感；对热敏感，<span lang=EN-US>56</span>℃条件下<span lang=EN-US>30</span>分钟可灭活。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 黑体; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体; mso-bidi-font-weight: bold">二、流行病学</span><span lang=EN-US style="FONT-SIZE: 16pt; COLOR: red; FONT-FAMILY: 黑体; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体"><o:p></o:p></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32.15pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><b style="mso-bidi-font-weight: normal"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 楷体_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">（一）传染源。<span lang=EN-US><o:p></o:p></span></span></b></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">甲型<span lang=EN-US>H1N1</span>流感病人为主要传染源，无症状感染者也具有传染性。目前尚无动物传染人类的证据。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32.15pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><b style="mso-bidi-font-weight: normal"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 楷体_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">（二）传播途径。<span lang=EN-US><o:p></o:p></span></span></b></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">主要通过飞沫经呼吸道传播，也可通过口腔、鼻腔、眼睛等处黏膜直接或间接接触传播。接触患者的呼吸道分泌物、体液和被病毒污染的物品亦可能引起感染。通过气溶胶经呼吸道传播有待进一步确证。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32.15pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><b style="mso-bidi-font-weight: normal"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 楷体_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">（三）易感人群。<span lang=EN-US><o:p></o:p></span></span></b></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">人群普遍易感。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32.15pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><b style="mso-bidi-font-weight: normal"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 楷体_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">（四）较易成为重症病例的高危人群。<span lang=EN-US><o:p></o:p></span></span></b></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">下列人群出现流感样症状后，较易发展为重症病例，应当给予高度重视，尽早进行甲型<span lang=EN-US>H1N1</span>流感病毒核酸检测及其他必要检查。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">1.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">妊娠期妇女；<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">2.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">伴有以下疾病或状况者：慢性呼吸系统疾病、心血管系统疾病（高血压除外）、肾病、肝病、血液系统疾病、神经系统及神经肌肉疾病、代谢及内分泌系统疾病、</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 仿宋_GB2312">免疫功能抑制<span lang=EN-US>(</span>包括应用免疫抑制剂或<span lang=EN-US>HIV</span>感染等致免疫功能低下<span lang=EN-US>)</span></span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: Arial">、</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 仿宋_GB2312">19</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 仿宋_GB2312">岁以下长期服用阿司匹林者</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: Arial">；</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体"><o:p></o:p></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">3.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">肥胖者（体重指数≥<span lang=EN-US>40</span>危险度高，体重指数在<span lang=EN-US>30-39</span>可能是高危因素）；<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">4.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">年龄＜<span lang=EN-US>5</span>岁的儿童（年龄＜<span lang=EN-US>2</span>岁更易发生严重并发症）；<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">5.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">年龄≥<span lang=EN-US>65</span>岁的老年人。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 黑体; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体; mso-bidi-font-weight: bold">三、临床表现和辅助检查</span><span lang=EN-US style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 黑体; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体"><o:p></o:p></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">潜伏期一般为<span lang=EN-US>1-7</span>天，多为<span lang=EN-US>1-3</span>天。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt 32pt"><b style="mso-bidi-font-weight: normal"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 楷体_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">（一）临床表现。<span lang=EN-US><o:p></o:p></span></span></b></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">通常表现为流感样症状，包括</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">发热、咽痛、流涕、鼻塞、咳嗽、咯痰、头痛、全身酸痛、乏力。部分病例出现呕吐和<span lang=EN-US>/</span>或腹泻。少数病例仅有轻微的上呼吸道症状，无发热。体征主要包括咽部充血和扁桃体肿大。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">可发生肺炎等并发症。少数病例病情进展迅速，出现</span><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">呼吸衰竭、多脏器功能不全或衰竭。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">可诱发原有基础疾病的加重，呈现相应的临床表现。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">病情严重者可以导致死亡。<b style="mso-bidi-font-weight: normal"><span lang=EN-US><o:p></o:p></span></b></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32.15pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><b style="mso-bidi-font-weight: normal"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 楷体_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">（二）实验室检查。<span lang=EN-US><o:p></o:p></span></span></b></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">1.</span><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">外周血象检查：白细胞总数一般不高或降低。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">2.</span><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">血生化检查：部分病例出现低钾血症<span lang=EN-US>,</span>少数病例肌酸激酶、天门冬氨酸氨基转移酶、丙氨酸氨基转移酶、乳酸脱氢酶升高。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">3.</span><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">病原学检查：<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">（<span lang=EN-US>1</span>）病毒核酸检测：以<span lang=EN-US>RT-PCR</span>（最好采用<span lang=EN-US>real-time RT-PCR</span>）法检测呼吸道标本（咽拭子、鼻拭子、鼻咽或气管抽取物、痰）中的甲型<span lang=EN-US>H1N1</span>流感病毒核酸，结果可呈阳性。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">（<span lang=EN-US>2</span>）病毒分离：呼吸道标本中可分离出甲型<span lang=EN-US>H1N1</span>流感病毒。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">（<span lang=EN-US>3</span>）血清抗体检查：动态检测双份血清甲型<span lang=EN-US>H1N1</span>流感病毒</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">特异性抗体水平呈<span lang=EN-US style="COLOR: black; mso-bidi-font-weight: bold">4</span><span style="COLOR: black; mso-bidi-font-weight: bold">倍或<span lang=EN-US>4</span>倍以上升高。<span lang=EN-US><o:p></o:p></span></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32.15pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><b style="mso-bidi-font-weight: normal"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 楷体_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">（三）胸部影像学检查。<span lang=EN-US><o:p></o:p></span></span></b></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">合并肺炎时肺内可见片状阴影。</span><span lang=EN-US style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体"><o:p></o:p></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 黑体; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体; mso-bidi-font-weight: bold">四、诊断<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">诊断主要结合流行病学史、临床表现和病原学检查，早发现、早诊断是防控与有效治疗的关键。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32.15pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><b style="mso-bidi-font-weight: normal"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 楷体_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">（一）疑似病例。<span lang=EN-US><o:p></o:p></span></span></b></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">符合下列情况之一即可诊断为疑似病例：<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">1.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">发病前<span lang=EN-US>7</span>天内与传染期甲型<span lang=EN-US>H1N1</span>流感确诊病例有密切接触，并出现流感样临床表现。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">密切接触是指在未采取有效防护的情况下，诊治、照看传染期甲型<span lang=EN-US>H1N1</span>流感患者；与患者共同生活；接触过患者的呼吸道分泌物、体液等。</span><span lang=EN-US style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体"><o:p></o:p></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">2.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">发病前<span lang=EN-US>7</span>天内曾到过</span><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">甲型<span lang=EN-US>H1N1</span>流感</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">流行（出现病毒的持续人间传播和基于社区水平的流行和暴发）的地区，出现流感样临床表现。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">3.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">出现流感样临床表现，甲型流感病毒检测阳性，尚未进一步检测病毒亚型。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">对上述<span lang=EN-US>3</span>种情况，在条件允许的情况下，</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">可安排甲型<span lang=EN-US>H1N1</span>流感病原学检查。</span><span lang=EN-US style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体"><o:p></o:p></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32.15pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><b style="mso-bidi-font-weight: normal"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 楷体_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">（二）临床诊断病例。<span lang=EN-US><o:p></o:p></span></span></b></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">仅限于以下情况作出临床诊断：</span><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">同一起甲型<span lang=EN-US>H1N1</span>流感暴发疫情中，未经实验室确诊的流感样症状病例，在排除其他致流感样症状疾病时，可诊断为临床诊断病例。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">甲型<span lang=EN-US>H1N1</span>流感暴发是指一个地区或单位短时间出现异常增多的流感样病例，经实验室检测确认为甲型<span lang=EN-US>H1N1</span>流感疫情。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">在条件允许的情况下，临床诊断病例可安排病原学检查。</span><b style="mso-bidi-font-weight: normal"><span lang=EN-US style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 楷体_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体"><o:p></o:p></span></b></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32.15pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><b style="mso-bidi-font-weight: normal"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 楷体_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">（三）确诊病例。<span lang=EN-US><o:p></o:p></span></span></b></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">出现流感样临床表现，同时有以下一种或几种实验室检测结果：<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">1.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">甲型<span lang=EN-US>H1N1</span>流感病毒核酸检测阳性（可采用<span lang=EN-US>real-time RT-PCR</span>和<span lang=EN-US>RT-PCR</span>方法）；<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">2.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">分离到甲型<span lang=EN-US>H1N1</span>流感病毒；<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">3.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">双份</span><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">血清甲型<span lang=EN-US>H1N1</span>流感病毒的</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">特异性抗体水平呈<span lang=EN-US style="COLOR: black; mso-bidi-font-weight: bold">4</span><span style="COLOR: black; mso-bidi-font-weight: bold">倍或<span lang=EN-US>4</span>倍以上升高。<span lang=EN-US><o:p></o:p></span></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 黑体; mso-font-kerning: 0pt; mso-bidi-language: TH; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体; mso-bidi-font-weight: bold">五、重症与危重病例<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 30.7pt; mso-char-indent-count: 1.92"><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体; mso-bidi-font-weight: bold">（一）出现以下情况之一者</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">为重症病例：<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 30.7pt; mso-char-indent-count: 1.92"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">1.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">持续高热＞<span lang=EN-US>3</span>天；<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 30.7pt; mso-char-indent-count: 1.92"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">2.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">剧烈咳嗽，咳脓痰、血痰，或胸痛；<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 30.7pt; mso-char-indent-count: 1.92"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">3.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">呼吸频率快，呼吸困难，口唇紫绀；<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 30.7pt; mso-char-indent-count: 1.92"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">4.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">神志改变：反应迟钝、嗜睡、躁动、惊厥等；<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 30.7pt; mso-char-indent-count: 1.92"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">5.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">严重呕吐、腹泻，出现脱水表现；<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 30.7pt; mso-char-indent-count: 1.92"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">6.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">影像学检查有肺炎征象；<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 30.7pt; mso-char-indent-count: 1.92"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">7.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">肌酸激酶（<span lang=EN-US>CK</span>）、肌酸激酶同工酶（<span lang=EN-US>CK-MB</span>）等心肌酶水平迅速增高；<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 30.7pt; mso-char-indent-count: 1.92"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">8.</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">原有基础疾病明显加重。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 30.7pt; mso-char-indent-count: 1.92"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">（二）</span><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体; mso-bidi-font-weight: bold">出现以下情况之一者为危重病例：<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体; mso-bidi-font-weight: bold">1.</span><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体; mso-bidi-font-weight: bold">呼吸衰竭；<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体; mso-bidi-font-weight: bold">2.</span><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体; mso-bidi-font-weight: bold">感染中毒性休克；<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体; mso-bidi-font-weight: bold">3.</span><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体; mso-bidi-font-weight: bold">多脏器功能不全；<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span lang=EN-US style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体; mso-bidi-font-weight: bold">4.</span><span style="FONT-SIZE: 16pt; COLOR: black; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体; mso-bidi-font-weight: bold">出现其他需进行监护治疗的严重临床情况。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 黑体; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">六、临床分类处理原则<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32.15pt; mso-char-indent-count: 2.0"><b style="mso-bidi-font-weight: normal"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 楷体_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">（一）疑似病例：</span></b><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">在通风条件良好的房间单独隔离。住院病例须做甲型<span lang=EN-US>H1N1</span>流感病原学检查。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32.15pt; mso-char-indent-count: 2.0"><b style="mso-bidi-font-weight: normal"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 楷体_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">（二）临床诊断病例：</span></b><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">在通风条件良好的房间单独隔离。住院病例须做甲型<span lang=EN-US>H1N1</span>流感病原学检查。</span><b style="mso-bidi-font-weight: normal"><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 楷体_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体"><o:p></o:p></span></b></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32.15pt; mso-char-indent-count: 2.0"><b style="mso-bidi-font-weight: normal"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 楷体_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">（三）确诊病例：</span></b><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">在通风条件良好的房间进行隔离。住院病例可多人同室。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0; mso-outline-level: 1"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 黑体; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">七、住院原则<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">根据患者病情及当地医疗资源状况，按照重症优先的原则安排住院治疗。<span lang=EN-US><o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">（一）优先收治重症与危重病例入院。对危重病例，</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-font-kerning: 0pt; mso-hansi-font-family: 宋体; mso-bidi-font-family: 宋体">根据当地医疗设施条件，及时转入具备防控条件的重症医学科（<span lang=EN-US>ICU</span>）治疗</span><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">。<span lang=EN-US> <o:p></o:p></span></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312">（二）不具备重症与危重病例救治条件的医疗机构，在保证医疗安全的前提下，要及时将病例转运到具备条件的医院；病情不适宜转诊时，当地卫生行政部门或者上级卫生行政部门要组织专家就地进行积极救治。</span><span lang=EN-US style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体"><o:p></o:p></span></p>
<p class=MsoNormal style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 32pt; mso-char-indent-count: 2.0"><span style="FONT-SIZE: 16pt; FONT-FAMILY: 仿宋_GB2312; mso-hansi-font-family: 宋体">（三）高危人群感染甲型<span lang=EN-US>H1N1</span>流感较易成为重症病例，宜安排住院诊治。如