20 19-02- 13

Influenza is an acute respiratory infectious disease caused by influenza virus, and it is also a highly contagious and fast-spreading disease. It is mainly spread through droplets in the air, contact between people or contact with contaminated items. Typical clinical symptoms are: sudden high fever, general pain, obvious fatigue and mild respiratory symptoms. Generally, autumn and winter are a high incidence period, resulting in serious complications and deaths. The disease is caused by influenza virus, which can be divided into three types: A, B and C. A virus often mutates its antigen, which is highly contagious, spreads quickly and is prone to widespread epidemic. Type a H 1N 1 is a type a. The disease is self-limited, but in infants, the elderly and patients with cardiopulmonary diseases, it is easy to be complicated with serious complications such as pneumonia and lead to death.

Etiology: influenza virus.

clinical picture

1. incubation period

The incubation period is usually 1 ~ 7 days, mostly 2 ~ 4 days.

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(1) Simple flu? Often sudden onset, chills and high fever, body temperature can reach 39℃ ~ 40℃, often accompanied by headache, muscle joint pain, extreme fatigue, loss of appetite and other systemic symptoms, often sore throat, dry cough, stuffy nose, runny nose, retrosternal discomfort and so on. Facial flushing, conjunctival canthus is slightly congested. If there are no complications, the process is self-limited. After 3-4 days of onset, the body temperature gradually subsides and the systemic symptoms improve, but cough and physical recovery often take 1 ~ 2 weeks. Mild flu is similar to the common cold, with mild symptoms and can be cured in 2 ~ 3 days.

(2) Pneumonia flu? In essence, it is complicated with influenza virus pneumonia, which is more common in the elderly, children and people with original cardiopulmonary diseases. The main manifestations are persistent high fever, severe cough, hemoptysis or purulent sputum, shortness of breath, cyanosis, and audible moist rales in the lungs. The chest film shows that both lungs are scattered in flocculent shadows. No pathogenic bacteria grow in sputum culture, and influenza virus can be isolated. Will die of respiratory and circulatory failure.

(3) Poisonous flu? It is characterized by high fever, shock, respiratory failure, central nervous system damage, disseminated intravascular coagulation and other serious symptoms, and the mortality rate is high.

(4) Gastrointestinal influenza? In addition to fever, vomiting, abdominal pain and diarrhea are obvious characteristics, and children are more than adults. It can be recovered in 2 ~ 3 days.

(5) Influenza in special population? Clinical manifestations ① Children's influenza? During the flu season. Generally, healthy children infected with influenza virus can show mild influenza, the main symptoms are fever, cough, runny nose, stuffy nose, sore throat and headache, and a few have myalgia, vomiting and diarrhea. The clinical symptoms of infant influenza are often atypical, and febrile convulsions may occur. Neonatal influenza is rare, but it is easy to be complicated with pneumonia, often manifested as septicemia, such as lethargy, refusal to milk, apnea and so on. Laryngitis, tracheitis, bronchitis, bronchiolitis, pneumonia and gastrointestinal symptoms caused by influenza virus are more common in children than in adults. ② Influenza in the elderly? Influenza patients over 65 years old are elderly people suffering from influenza. Because the elderly often have primary diseases such as respiratory system and cardiovascular system, the illness of the elderly infected with influenza virus is more serious, the disease progresses rapidly, and the incidence of pneumonia is higher than that of young adults. Other system injuries mainly include abnormal electrocardiogram, heart failure, acute myocardial infarction, encephalitis and poor blood sugar control caused by influenza virus myocarditis. ③ Pregnant women with influenza? In addition to fever and cough, pregnant women in the second and third trimester of pregnancy are prone to pneumonia, shortness of breath, hypoxemia and even acute respiratory distress syndrome, which can lead to abortion, premature delivery, fetal distress and intrauterine death. It can induce the aggravation of the original basic disease, and the serious condition can lead to death. ④ Influenza in immunocompromised people? People with immune deficiency, such as organ transplant recipients, AIDS patients and long-term immunosuppressants, have a significantly increased risk of severe influenza after being infected with influenza virus. Due to the susceptibility to influenza virus pneumonia, fever, cough, dyspnea and cyanosis can occur rapidly after the onset, and the mortality rate is high.

Four inspections

1. Peripheral blood test

The total number of white blood cells is generally not high or low, and lymphocytes increase. Serious cases will rise. If combined with bacterial infection, the total number of white blood cells and neutrophils increases.

2. Blood biochemical examination

Hypokalemia occurred in some cases, and creatine kinase, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase and creatinine increased in a few cases.

3. Etiology related examination

It mainly includes virus isolation, virus antigen, nucleic acid and antibody detection. Virus isolation is the main method of laboratory detection; Virus antigen and nucleic acid detection can be used for early diagnosis; Antibody detection can be used for retrospective investigation, but it is of little significance for early diagnosis of cases.

4. Image inspection

Some patients may show signs of bronchial infection with increased bronchial texture, and in severe cases, pulmonary infiltrative lesions or pleural effusion may occur, even with patches.

Five diagnoses

Diagnosis can be made according to the etiology, clinical manifestations and laboratory examination.

Etiological related examination: mainly including virus isolation, virus antigen, nucleic acid and antibody detection. Virus isolation is the "gold standard" for the diagnosis of this disease; Virus antigen and nucleic acid detection can be used for early diagnosis; Antibody detection can be used for retrospective investigation, but it is of little significance for early diagnosis of cases.

1. Virus nucleic acid detection

RT-PCR (preferably real time? Detection of influenza virus nucleic acid in respiratory tract samples (throat swab, nose swab, nasopharyngeal or tracheal extract, sputum) by RT-PCR. The specificity and sensitivity of virus nucleic acid detection are the best, which can quickly distinguish virus types and subtypes, and the results can usually be obtained in 4-6 hours.

2. Virus isolation and culture

Influenza virus was isolated from respiratory tract samples. In the influenza epidemic season, it is suggested that virus isolation should be carried out for patients with negative rapid antigen diagnosis and immunofluorescence detection of influenza-like cases.

3. Virus antigen detection (rapid diagnostic reagent detection)

The rapid antigen detection method can detect mucosal epithelial cells in respiratory tract samples (throat swabs, nasal swabs, nasopharyngeal or tracheal extracts) by immunofluorescence, and distinguish influenza A and B by monoclonal antibodies, and the results can usually be obtained within a few hours. There are other colloidal gold tests, which can generally be carried out at 10 ~ 30? We'll get the results in a few minutes. The interpretation of rapid test results should be combined with the epidemic history and clinical symptoms of patients: in non-epidemic period, positive screening results may be false positive; In epidemic period, the result of negative screening test may be false negative; In these two cases, RT-PCR or virus isolation and culture should be considered for further confirmation.

4. Serological diagnosis

The specific IgM and IgG antibody levels of influenza virus were detected. The dynamic detection of IgG antibody level in recovery period is more than 4 times higher than that in acute period, which has retrospective diagnostic significance.

Six complications

(1) bacterial pneumonia? The incidence was 5 ~ 15%. 2 ~ 4 days after the onset of influenza, the condition is further aggravated, or it is aggravated after the recovery of influenza, with high fever, severe cough, purulent sputum, dyspnea, lung moist rales and signs of lung consolidation. The total number of white blood cells and neutrophils in peripheral blood increased significantly, mainly streptococcus pneumoniae and staphylococcus aureus, especially methicillin-resistant staphylococcus aureus, streptococcus pneumoniae or Haemophilus influenzae.

(2) Pneumonia caused by other pathogens? Including chlamydia, mycoplasma, Legionella pneumophila, fungi (Aspergillus) and so on. The possibility of fungal infection should be considered when the pneumonia of influenza patients is ineffective after routine anti-infection treatment.

(3) Other viral pneumonia? Common rhinovirus, coronavirus, respiratory syncytial virus, parainfluenza virus, etc. It has a high incidence in patients with chronic obstructive pulmonary disease and can aggravate the condition, which is difficult to distinguish from pneumonia caused by influenza virus in clinic. Related etiological and serological examinations are helpful for differential diagnosis.

(4) Reye syndrome? Occasionally seen in/kloc-children under 0/4 years old, especially those who use salicylic acid antipyretic and analgesic drugs such as aspirin. The main manifestations are nausea, vomiting, lethargy, coma, convulsions and other nervous system symptoms after fever. Liver is big, there is no jaundice, and cerebrospinal fluid examination is normal. The pathogenesis is still unclear.

(5) heart damage? Heart injury is uncommon, mainly myocarditis and pericarditis. It can be seen that creatine kinase is elevated and ECG is abnormal, while troponin is rare and can be recovered. In severe cases, heart failure will occur.

(6) nervous system damage? Including encephalomyelitis, transverse myelitis, aseptic meningitis, focal neurological dysfunction, acute infectious demyelinating polyradiculopathy (Guillain-Barre syndrome).

(7) Myositis and rhabdomyolysis syndrome? It's rare in flu. The main symptoms are myasthenia, renal failure and CK elevation.

Seven therapies

1. General symptomatic treatment

Stay in bed, drink plenty of water, give a liquid or semi-liquid diet, be suitable for nutrition, supplement vitamins, rinse your mouth with warm boiled water or warm salt water after meals, keep your mouth and nose clean, and give anti-infection treatment when systemic symptoms are obvious.

2. Principles of treatment

Early application of antiviral therapy. We should adhere to the principle of paying equal attention to preventive isolation and drug treatment, and paying equal attention to etiological treatment and symptomatic treatment. The basic principles include early use of anti-influenza drugs, avoiding blind or improper use of antibacterial drugs, strengthening supportive treatment, preventing complications, and rational use of symptomatic treatment drugs.

Start anti-influenza drug treatment as soon as possible within 36 hours or 48 hours of onset. Although some data show that neuraminidase inhibitors can take effect within 48 hours after onset, most studies have proved that early treatment is more effective.

(1) Application instruction

1) recommended? ① Adults and children who are confirmed by laboratory etiology or highly suspected of influenza with high risk factors of complications should be treated within 48 hours of onset, regardless of the basic disease, immune status of influenza vaccine and severity of influenza. ② For adults and children who are diagnosed in the laboratory or highly suspected of influenza and need hospitalization, if the samples of influenza virus are positive 48 hours after onset, antiviral drugs are also recommended for treatment regardless of the basic disease and the immune status of influenza vaccine.

2) consider using? ① Adult and child influenza outpatients who are clinically suspected to have high risk factors of influenza complications, whose condition has not improved for more than 48 hours after onset, and whose specimens are positive after 48 hours. ② Patients with high clinical suspicion or laboratory diagnosis of influenza, without risk factors of complications and within 48 hours of onset can also benefit from antiviral therapy, but there is no prospective study and evaluation on its safety and effectiveness.

(2) Specific drugs

1) neuraminidase inhibitor? The mechanism of action is to prevent the virus from being released from infected cells, invade neighboring cells, and reduce the replication of the virus in the body. It is active against influenza A and B. There are two varieties listed in China, namely oseltamivir and zanamivir. A large number of clinical studies show that neuraminidase inhibitors can effectively alleviate the symptoms of influenza patients, shorten the course of illness and hospitalization time, reduce complications, save medical expenses, and may reduce the mortality rate of some people, especially when used early within 48 hours of onset.

As an oral dosage form, oseltamivir is approved for children and adults aged > 1, and children and adults aged 5 years (UK) or 7 years (USA). Comparative study shows that there is no difference between its curative effect and oseltamivir. Occasionally, it can cause bronchospasm and allergic reaction. Patients with basic diseases such as asthma should use it with caution, and other adverse reactions are less.

2 )M2 ion channel blocker? Blocking the ion channel of M2 protein of influenza virus, thus inhibiting virus replication, but only inhibiting influenza A virus. Include amantadine and rimantadine. Adverse reactions of nervous system include nervousness, anxiety, inattention and mild headache, which are more common in amantadine. Gastrointestinal reactions include nausea, vomiting, etc., most of which are mild and can disappear quickly after stopping taking drugs. These two drugs are prone to drug resistance.

3) Is the dosage for children different from that for adults? Same course of treatment. In an emergency, oseltamivir can be used for infants over 3 months old. Even if the time is more than 48 hours, antiviral treatment should be carried out.

(3) Support the treatment and prevention of complications.

Pay attention to rest, drink plenty of water, increase nutrition and give a digestible diet. Mainly to supplement vitamins, rinse your mouth with warm boiled water or warm salt water after meals, and keep your mouth and nose clean. Maintain water-electrolyte balance. Close observation, monitoring and prevention of treatment complications.

(4) Rational use of related drugs

Influenza is a common viral infectious disease, and antibiotics have no effect on the treatment of influenza virus. Therefore, in the absence of signs of bacterial infection, antibiotics should not be used, otherwise it will easily lead to double infection or drug-resistant bacteria. Use antibiotics in time when secondary bacterial infection occurs. Because fever is a prominent symptom of influenza, and the application of antipyretic aspirin can lead to Reye's syndrome, it is easy to choose physical cooling when dealing with fever in influenza patients and try to avoid using large doses of aspirin.

8. Prognosis: The course of influenza is self-limited, and patients without complications can generally heal themselves within 5 ~ 10 days. However, serious infection or complications require hospitalization; The high-risk groups of severe cases are mainly the elderly, young children, pregnant women or those with chronic basic diseases; A few serious cases may die of respiratory or multiple organ failure.

Prevention: Seasonal influenza has strong interpersonal communication ability, and active prevention and control is more important than limited effective treatment measures. The main preventive measures are as follows.

Strengthen the publicity and education of personal hygiene knowledge

1. Keep indoor air circulation and avoid going to crowded places in peak season.

2. Use paper towels when coughing or sneezing to avoid the spread of droplets.

3. Wash your hands often and thoroughly to avoid dirty hands touching your mouth, eyes and nose.

4. If flu-like symptoms appear during the epidemic, seek medical advice in time, reduce contact with others and try to rest at home.

5. Influenza patients should be isolated from respiratory tract 1 week or until the main symptoms disappear. The patient's utensils and secretions should be thoroughly disinfected.

6. Strengthen outdoor physical exercise to improve the body's disease resistance.

7. The climate in autumn and winter is changeable, so pay attention to adding and subtracting clothes.

8. Vaccination against influenza: Vaccination against influenza is the most effective means to prevent influenza and its complications, which is irreplaceable by other methods. Vaccines need to be vaccinated every year to be effectively protected, and the replacement of vaccine strains is decided by WHO according to the global monitoring results. Priority vaccination population:

(1) People with high risk of complications after influenza? (1) infants aged 6-59 months. ② Older people over 60 years old. ③ Adults and children with chronic respiratory diseases, cardiovascular diseases, nephropathy, liver diseases, hematological diseases and metabolic diseases. ④ Adults and children with immunosuppressive diseases or low immune function. ⑤ People who can't take care of themselves and people who are at risk of aspiration such as upper respiratory secretions due to difficulty in self-expectoration caused by nervous system diseases. ⑥ Long-term residence in nursing institutions for chronic diseases such as sanatoriums. ⑦ Pregnant women and women who plan to get pregnant during the flu season. ⑧65438+ Teenagers under the age of 08 who have been treated with aspirin for a long time.

(2) People who have a greater chance to spread influenza virus to high-risk groups? ① Medical and health workers. (2) nursing homes, nursing homes and other chronic disease care institutions staff. ③ Family members and caregivers of people at high risk of post-influenza complications.

(3) taboo? ① allergic to egg protein or any vaccine. ② Patients with moderate and severe acute fever. ③ Patients with Guillain-Barre syndrome. The doctor thinks that others can't get the flu vaccine.

(4) Inoculation method and timing? ① Children from 6 months to 9 years old who have never been vaccinated with influenza vaccine or who have only been vaccinated with 1 dose in the previous year should be vaccinated with 2 doses with an interval of 4 weeks; Inoculate 1 dose before influenza season every year in the future. Others take 1 dose every year. ② Inoculation route is intramuscular injection or subcutaneous deep injection, and it is recommended that infants choose intramuscular injection of lateral thigh. ③ Vaccination should be started in most areas of China before 10 every year.

10. antiviral drug prevention: drug prevention can not replace vaccination, but can only be used as an emergency temporary preventive measure for high-risk groups with complications who have not been vaccinated or have not gained immunity after vaccination. Antiviral drugs sensitive to epidemic strains should be selected as preventive drugs, and the course of treatment is determined by doctors, usually 1 ~ 2 weeks. It is estimated that it is difficult to obtain effective immune effect for people who have been vaccinated but are immunosuppressed for various reasons. Whether to add antiviral drugs for prevention and the timing, course of treatment and dosage of administration should also be judged by doctors.

(1) TCM prevention: those who have clear contact with influenza patients: ① Children, young adults and people in good health can take the following: honeysuckle, folium Isatidis, mint and raw licorice, one capsule per day, for 5 days. ② For the elderly and infirm, Radix Codonopsis, Folium Perillae and Herba Schizonepetae can be decocted in water, daily 1 dose for 5 days.

(2) Dietary attention: After suffering from the flu, you should eat a light diet and eat more foods that are digestible and rich in vitamins. At the same time, pay attention to drink plenty of water, mainly boiled water. Do not eat salty food: after eating salty food, it is easy to contract the mucosa of the affected area and aggravate nasal congestion. Symptoms such as throat discomfort. Moreover, salty food is easy to produce phlegm and stimulate local cough. Fasting sweet and greasy food: sweet food can help wet, but greasy food is not easy to digest, so patients with cold should avoid all kinds of candy, drinks, fat and so on. Fasting spicy food: spicy food is easy to burn body fluid, which helps fire to produce phlegm, making it difficult to cough up phlegm, so people with colds should not eat it, especially onions. It is not suitable to eat barbecue and fried foods: the smell of such foods stimulates the respiratory tract and digestive tract, which easily leads to mucosal contraction, aggravates the condition and is not easy to digest. At the same time, you should also avoid alcohol and tobacco.

Ten nursing care

For hospitalized influenza patients, nurses should do the following:

1. During the fever period, you should be instructed to stay in bed, drink plenty of boiled water, regularly monitor your body temperature, and take Chinese patent medicines or antiviral drugs such as Yinqiao Jiedu tablets and Sangju Ganmao tablets;

2. For those who have obvious body aches or headaches, help patients take comfortable positions and take antipyretic and analgesic drugs when necessary;

3. Patients with pulmonary inflammation or cardiopulmonary insufficiency should closely monitor vital signs. People with dyspnea or cyanosis should take a semi-recumbent position, give oxygen, clear respiratory secretions in time, strengthen supportive treatment and pay attention to maintaining cardiovascular function. Effective antibiotics or hormones can be used to treat poisoning symptoms;

The patient can be isolated from the respiratory tract until the heat recedes for 48 hours, indoor ventilation should be strengthened, and the respiratory secretions of the patient should be disinfected in time. Tableware, utensils and clothes can be boiled or disinfected in the sun.

Generally, simple influenza can not be hospitalized, so family care can be carried out in the following aspects: ① Put the patient in a single room to prevent the spread of droplets; (2) Indoor ventilation is good, and the air is fumigated and disinfected with vinegar regularly. When taking care of patients, you should wear a mask to disinfect patients' respiratory secretions and dirt (such as expectoration); ③ For patients with high fever, family members should be instructed to use physical cooling methods and use antipyretic drugs correctly; ④ Give a light diet with rich nutrition and easy digestion, and encourage patients to drink more water, so as to alleviate the symptoms of poisoning and shorten the course of disease; ⑤ If you have persistent high fever, cough, purulent sputum and dyspnea, you should be sent to the hospital in time.