Division of Respiratory Medicine, The Chinese University of Hong Kong, 9/F, Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, New Territories, Hong Kong.
Chest. 2010 Apr;137(4):916-25. doi: 10.1378/chest.09-2344. Epub 2009 Dec 18.
Antiviral therapy and vaccination are important strategies for controlling pandemic 2009 influenza A(H1N1) but efficacy depends on the timing of administration and is often limited by supply shortage. Patients with dyspnea, tachypnea, evidence of hypoxemia, and pulmonary infiltrates on chest radiograph should be hospitalized. Patients with severe illness or underlying medical conditions that increase the risk of more severe disease should be treated with oseltamivir or zanamivir as soon as possible, without waiting for the results of laboratory tests. Lung-protective ventilation strategy with a low tidal volume and adequate pressure, in addition to a conservative fluid management approach, is recommended when treating adult patients with ARDS. Extracorporeal membrane oxygenation has emerged as an important rescue therapy for critically ill patients. Use of systemic steroids was associated with delayed viral clearance in severe acute respiratory syndrome and H3N2 infection. Low-dose corticosteroids may be considered in the treatment of refractory septic shock. Passive immunotherapy in the form of convalescent plasma or hyperimmune globulin may be explored as rescue therapy. More data are needed to explore the potential role of IV gamma globulin and other drugs with immunomodulating properties, such as statins, gemfibrozil, and N-acetyl-cysteine. Health-care workers must apply strict standard and droplet precautions when dealing with suspected and confirmed case and upgrade to airborne precautions when performing aerosol-generating procedures. Nonpharmacologic measures, such as early case isolation, household quarantine, school/workplace closure, good community hygiene, and restrictions on travel are useful measures in controlling an influenza pandemic at its early phase.
抗病毒治疗和疫苗接种是控制大流行 2009 年甲型 H1N1 流感的重要策略，但疗效取决于给药时机，并且常常受到供应短缺的限制。有呼吸困难、呼吸急促、低氧血症证据和胸片肺部浸润的患者应住院治疗。有严重疾病或增加疾病严重程度风险的潜在医疗条件的患者应尽快接受奥司他韦或扎那米韦治疗，而无需等待实验室检测结果。对于患有 ARDS 的成年患者，建议采用低潮气量和足够压力的肺保护性通气策略，以及保守的液体管理方法。体外膜氧合已成为危重症患者的重要抢救治疗方法。在严重急性呼吸综合征和 H3N2 感染中，全身使用皮质类固醇与病毒清除延迟有关。在治疗难治性感染性休克时，可以考虑使用低剂量皮质类固醇。可以探索恢复期血浆或高免疫球蛋白等被动免疫疗法作为抢救治疗。需要更多的数据来探索 IV 免疫球蛋白和其他具有免疫调节特性的药物（如他汀类药物、吉非贝齐和 N-乙酰半胱氨酸）的潜在作用。医护人员在处理疑似和确诊病例时必须采取严格的标准和飞沫预防措施，在进行气溶胶生成操作时升级为空气传播预防措施。在流感大流行的早期阶段，非药物措施，如早期病例隔离、家庭检疫、学校/工作场所关闭、良好的社区卫生和旅行限制，是控制流感大流行的有用措施。
