中东呼吸综合症新疗法.doc

中东呼吸综合症新疗法中东呼吸综合征（MERS）、H7N9亚型等禽流感等RNA病毒所致流行性疾病中西药结合治疗新良法中国湖北省浠水县妇幼保健院 陶新 联系电话：[phone] 中东呼吸综合征（MERS）及禽流感等RNA病毒致病近期发病危重，世界上发达国家虽然多有较好的预防措施，但是世界各地尚无治疗良法，本人从禽流感及中东呼吸综合征等RNA病毒致疾病的病理生理学角度探索出治疗禽流感及中东呼吸综合征等RNA病毒致病中西药结合治疗新良法，现将中东呼吸综合征（MERS）、H7N9亚型等禽流感等RNA病毒所致流行性疾病中西药结合治疗新良法告诉世人旨意现在和今后帮助大家消除对中东呼吸综合征（MERS）、H7N9亚型等禽流感等RNA病毒所致流行性疾病的恐惧并在中东呼吸综合征（MERS）、H7N9亚型等禽流感等RNA病毒致病的防治办法方面起抛砖引玉作用，供大家指教、参考。中东呼吸综合征及H7N9亚型等禽流感等等RNA病毒致病正在世界发生并造成极大危害，危重症、死亡病例急剧增加。中东呼吸综合征及H7N9禽流感病毒等RNA病毒是全球首次发现的新RNA病毒，我们不能排除中东呼吸综合征及H7N9亚型等禽流感等RNA病毒的传染性、侵袭性变强可能性，我们更要正视人类目前对病毒认识的有限性和病毒的可怕性。为早日挽救感染者生命和降低全社会对中东呼吸综合征及H7N9亚型禽流感等RNA病毒致疾病的恐慌，为防止现在和今后许多类型RNA病毒致病导致防治人类疲于奔命，笔者献出多年对属于RNA病毒导致的急性病中西药结合临床治疗研究方案，为治疗中东呼吸综合征及禽流感等RNA病毒致病献计献策。一、中东呼吸综合征、H7N9亚型等禽流感等RNA病毒致病现状及其严重性1、中东呼吸综合征、H7N9亚型等禽流感等RNA病毒致病目前虽然发病率不高，但其死亡率较高，死亡病例各年龄段不等，H7N9亚型等禽流感、中东呼吸综合征等RNA病毒致病死亡病例特点系吸烟男性居多及老年体弱者居多。2、中东呼吸综合征、H7N9亚型等禽流感等RNA病毒致病传染性较强（可通过接触传染、空气传染，中东呼吸综合征等在韩国已出现人对人第三代、第四代传染。），但人与人、人与禽接触机会太多了：人际来往是必需的、禽鸟满天飞、家禽野禽满地跑、人类不可能灭绝禽类、骆驼是沙漠之舟，动物是许多新型传染病爆发的推手。3、中东呼吸综合征、H7N9亚型等禽流感等RNA病毒致病早期病人好像没什么感觉，但是到了7到11天病情突然加重，大部分病人还是呼吸衰竭，因为它侵犯的主要部位是肺部，其次是小血管、肺、肾等脏器，导致肺部氧合能力差，机体多脏器功能衰竭。4、中东呼吸综合征、H7N9亚型等禽流感等RNA病毒致病发病急、病情危重、致死时间短，危重症救治很困难。5、目前没有特异性预防疫苗，更无特异性杀H7N9亚型禽流感病毒及中东呼吸综合征等RNA病毒药物。6、中东呼吸综合征、H7N9亚型等禽流感等RNA病毒致病病毒属于RNA病毒，RNA 病毒疫苗的无交叉免疫作用，如甲型H1N1流感疫苗对其无保护作用。7、近几年多地送检近千份样品，其中H7N9禽流感及中东呼吸综合征阳性样品：包括鸡样品、鸭样品、环境样品、鸽子样品、骆驼样品。阳性样品的广泛性，飞禽移动的不确定性极其危害人类，要知道已有报道人未与禽类接触而发病的可怕性。8、人类经历2009年甲型H1N1流感流行先是恐慌后则轻视这个过程，导致人们对H7N9亚型禽流感及中东呼吸综合征等流行病防治易麻痹大意，导致疾病潜在性危害极大。 9、人类目前对禽流感及中东呼吸综合征的防治措施不科学性和中东呼吸综合症和H7N9亚型禽流感高致死性导致人类不科学高额代价（盲目耗费大量人力、物力、财力）防治中东呼吸综合征及H7N9亚型禽流感发病。10、随着气候的变化，时间的迁延，不排除禽流感病毒及中东呼吸综合征病毒的毒力、侵袭力发生进一步增强或变异给人类带来更大的灾难。目前中东呼吸综合征、H7N9亚型等禽流感等RNA病毒的毒力、侵袭力可能弱于SARS病毒。二、中东呼吸综合征及H7N9亚型等禽流感等等RNA病毒致病并不可怕1、人感染的中东呼吸综合征及H7N9禽流感病毒等等RNA病毒，是全球首次发现的新亚型流感病毒。2、中东呼吸综合征病毒及禽流感病毒等等病毒属于RNA病毒的正黏病毒科，禽流感病毒属正粘病毒科甲型流感病毒属。此次出现的为人感染H7N9禽流感病毒，该病毒为新型重配病毒，其内部基因来自于H9N2禽流感病毒，属RNA病毒。 3、RNA病毒感染大多为急性一过性、自限性感染性发病：SARS 病毒、甲流、季节性流感病毒、乙型脑炎病毒、出血热病毒、麻疹病毒、腮腺炎病毒、人禽流感病毒、西班牙流感病毒致病等等。流感病毒及中东呼吸综合征等等病毒致病也是一过性、自限性感染性疾病。4、RNA病毒感染大多获得较持久免疫力：SARS、甲流、出血热、腮腺炎病、麻疹、乙型脑炎等等。RNA病毒致病大多数是自限性疾病 只要度过发病危险期，许多病人不进行特殊治疗病人仍可自行康复，禽流感病毒及中东呼吸综合征等等病毒致病也是如此。目前只有艾滋病RNA病毒感染暂未发现人类机体获得自身免疫力，艾滋病可反复发病。5、RNA病毒或和机体免疫系统大多为一过性破坏被病毒亲合的人体组织细胞：季节性流感病毒、乙型脑炎病毒、出血热病毒、麻疹病毒、腮腺炎病毒、人禽流感病毒、西班牙流感病毒、中东呼吸综合征病毒等等。RNA病毒或和机体异常免疫大多数为一次性破坏组织细胞，只有艾滋病病毒除外，因为它是亲合机体免疫系统T细胞的，故而它是反复破坏机体免疫系统的，而机体免疫系统也无能力杀灭它。6、RNA病毒大多数在短期内被机体免疫系统一过性破坏而不是反复发病、反复破坏人体组织细胞：SARS 病毒、甲型H1N1病毒、季节性流感病毒、乙型脑炎病毒、出血热病毒、麻疹病毒、腮腺炎病毒、人禽流感病毒、西班牙流感病毒、中东呼吸综合征病毒等等，它们致机体发病后常在所致疾病病愈前病毒检查转阴。只有艾滋病病毒不转阴。7、大多数RNA病毒致病治愈并不需要特异性针对RNA病毒治疗，仅仅需要早期针对疾病的病理生理变化治疗即可治愈。如季节性流感、SARS、出血热病、乙型脑炎、甲型流感等等。8、无论任何流感类病毒怎么变异，万变不离其宗属于RNA病毒，现在乃至今后我们只要做到早认识其发病机理、早认识其病理生理变化、早确诊其病对易感人群先凭临床症状，紧跟RNA病毒检测、早治疗其病症状轻微时就下猛药：抗病毒、免疫抑制等治疗、早保护易感人群早隔离病人、早消灭病源、早切断传染途径，我们都能战胜绝大多数RNA病毒致病。当然有效高价特异性疫苗研究和推广是预防传染病十分重要手段。三、中东呼吸综合征及H7N9亚型禽流感（大多数RNA病毒急性致病）等可能致病机理及其特点1、中东呼吸综合征及H7N9亚型禽流感等临床表现与SARS、甲型H1N1流感、季节性流感等高度相似：均上感症状、高热、严重肺炎、急性呼吸衰竭。H7N9亚型禽流感及中东呼吸综合征的致病机理特点应与SARS、甲型H1N1流感等相似。2、中东呼吸综合征及禽流感等病毒（大多数RNA病毒急性致病）感染时病毒导致与病毒有亲合作用的相应器官、组织、细胞一次性损害症状及体征。如：上呼吸道炎、肺炎、脑炎、广泛性血管内皮炎（出血热）、腮腺炎等等及其并发症：呼衰、心衰、肾衰、脑水肿、休克等。3、对上呼吸道及肺部有亲合性的RNA病毒，它们一旦吸入到肺组织就会导致三种肺炎发生：吸入性病毒肺炎、免疫性肺炎、细菌性肺炎。4、免疫性肺炎的肺组织损伤不是H7N9亚型禽流感及中东呼吸综合征等病毒单纯直接损伤结果，是人机体感染H7N9亚型禽流感病毒后人机体对病毒所发生的系列免疫攻击，导致受H7N9亚型禽流感病毒及中东呼吸综合征等病毒感染部位免疫变态反应（主型变态反应）损伤正常组织，以及系列连锁损伤反应所致，因其病毒与支气管及肺组织的亲合性强，抗原性特异性较高。5、大家知道，机体免疫功能低下的人、体弱病者、长期应用免抑制药物者患危急重型出血热病和SARS病少，而免疫力强的青壮年人易发生急性危重型出血热病和SARS病（可能其病毒免疫反应性极强），同样H7N9亚型禽流感及中东呼吸综合征等也是导致大量受感染的中老年人死亡（可能其病毒免疫反应性较强）。6、长期吸烟者痰不易咳出，是因为长期吸烟者气管支气管黏膜上的纤毛上皮细胞受损之故。痰液不易咳出时H7N9亚型禽流感及中东呼吸综合征等病毒就易集聚于肺中。7、我们要正视对此类疾病治疗仅用针对其异常的病理生理进行纠正即可痊愈的现有的、大量的、真实的事实，我们要探索和发现此类疾病发病及治疗内在联系及规律。四、中东呼吸综合征及H7N9亚型禽流感及中东呼吸综合征等RNA病毒所致疾病的中西药防治新办法1、抗病毒治疗：要持续尽早足量全程，因病毒被机体免疫破坏是“全或无”现象。（1）、西药抗病毒治疗：西药可用帕拉米韦、达菲、乐感清、干扰素等（中东呼吸综合征及H7N9亚型禽流感病毒是其中的一种，同样含血凝素和神经氨酸酶），但要注意用帕拉米韦、达菲、乐感清等药物的耐药性和副作用。（2）、中药抗病毒治疗：可直接广谱抗病毒或诱导产生干扰素等广谱抗病毒物质产生的中药。（3）、抭细菌治疗：病毒感染后如并发细菌感染时，应用广谱抭生素。2、早期确保有效排祛病毒（痰中含大量病毒并不断繁殖）治疗（1）、西药排病毒治疗：用稀释痰液的球蛋白酶等；用盐酸溴己新（必嗽平、必消痰）、盐酸氨溴索片（沐舒坦）等；加大力度雾化、吸痰；要严禁使用6542等抑制腺体分泌药导致痰液粘稠不易咳排。（2）、中药排病毒治疗：用稀释痰、祛痰法中药促痰咳排，禁忌使用中枢或外周麻醉性止咳药物，严防阻碍祛痰问题。3、阻止或减轻本病的病理生理变化即可阻止或减轻肺组织、小血管等受损方面的治疗办法。（1）、免疫抑制治疗。大量使用清热解毒中药提升机体非特异性免疫，应用中药免疫抑制（抑制特特异性免疫，尤其体液免疫）预防并治疗，短期选用大剂量皮质激素冲击疗法，我们知道皮质激素尤其是长期大剂量皮质激素的严重副作用严重。中药免疫抑制治疗药物能早期应用，作用效果好，副作用极少。（2）、活血化瘀治疗。病程各期均应使用活血化瘀药物以防治肺微循环障碍，尤其是在可能要并发免疫性肺炎时要用，严禁使用促凝药物。活血化瘀治疗可解善组织细胞水肿及缺血、缺氧，减少有害机体细胞物质过氧化脂质产生。要强调对机体组织细胞已损害和正在损害和将被损害综合防治。用药：大剂量复方丹参液。（3）、应用修复小血管内皮药物并应用抗血管内皮外渗防治肺水肿及肺透明膜变（主要是纤维蛋白和细胞碎片组成），常用药品：大剂量维生素C及适量低分子右旋糖酐并使用活血化瘀药物。（4）、应加强并发症及合并症的治疗。当H7N9亚型禽感染流感中东呼吸综合征等的确诊或疑似患者要密切观察病情变化。如果青壮年人持续高烧二十四小时以上或老弱病者中度持续发烧二十四小时以上、剧烈咳嗽尤其刺激性干咳、胸闷、胸痛、胸腔积液、呼吸急促、呼吸困难、大汗淋漓、脸色发青、口唇及四肢末梢青紫、血氧饱和度下降、咳血性痰液尤其是血性沫痰或肺中量或大量出血、X线肺部炎症反应尤其是肺部炎症实性变和炎症部位多变、低血糖或肾功能衰竭、败血症、休克、全血细胞和血小板减少等任何一种危险症状等需要高度重视致死性肺病变的可能发生要给予高度重视。病毒性肺炎也常合并细菌性肺炎，我们对此也要严加防治。（5）、应用呼吸机，加用肺泡表面活性物质对患者康复有特效4、对病源消毒、隔离。 五、目前中东呼吸综合征及H7N9亚型禽流感等RNA病毒所致疾病的治疗误区1、早发现、早治疗不到位：中东呼吸综合征及H7N9亚型禽流感等早期症状轻微，类似上感易忽视，让H7N9亚型禽流感中东呼吸综合征等病毒在人上呼吸道及肺部得以生长繁殖。H7N9亚型禽流感中东呼吸综合征等病毒早期与人上呼吸道及肺部发生异常免疫反应不能及早阻止，一旦全面发生疾病后果严重。2、过分重视中东呼吸综合征及H7N9亚型禽流感等抗病毒治疗，忽视中东呼吸综合征及H7N9亚型禽流感等异常免疫反应防治：暂无特效抗中东呼吸综合征及H7N9亚型禽流感病毒药物，异常免疫反应一旦全面发生疾病后果严重。 3、错误重视中东呼吸综合征及H7N9亚型禽流感等免疫增强剂治疗，免疫增强剂不仅不能杀灭中东呼吸综合征及H7N9亚型禽流感等病毒，反而使中东呼吸综合征及H7N9亚型禽流感等病毒导致上呼吸道及肺部异常免疫反应增强，疾病的破坏性更大。4、快速排清病毒性痰液力度不够，使病毒得以在上呼吸道及肺部大量生长繁殖。5、快速抑制上呼吸道及肺部异常免疫反应力度不够，使异常免疫反应在上呼吸道及肺部破坏发生恶性循环。6、尽早综合防治上呼吸道及肺部破坏力度不够：没有应用活血化瘀药物以防治肺微循环障碍；没有应用抗过氧化物药物以防肺组织进一步被损害；没有应用胶体物质防治肺水肿及肺透明膜变。7、部分医务工作者过分依赖“权威”治疗方案，不敢进行大胆临床探索。8、为了不增加社会负担、为了不增加政府压力，我们要充分发挥中西医结合治疗疾病优势，作为任何一名医务工作者，我们必须应尽自己职责大胆工作，进行大胆临床探索。Respiratory syndrome (MERS) in the Middle East, such as H7N9 subtype avian influenza RNA virus epidemic disease caused by combination of Chinese and western medicine treatment of the new lawChinas hubei province xishui county maternity and child care taoxin tel:[phone]Respiratory syndrome in the Middle East (MERS) and avian influenza RNA virus pathogenic recent onset critically ill, the developed countries in the world although there are many good prevention measures, but there have been no treatment law all over the world, I am from avian flu, and the Middle East in the pathophysiology of RNA viruses cause diseases such as respiratory syndrome perspective to explore the treatment of avian flu, and the Middle East respiratory syndrome RNA virus pathogenic combination of Chinese and western medicine treatment of the new law, such as respiratory syndrome (MERS) is now the Middle East, such as H7N9 subtype avian influenza pandemic caused by RNA viruses such as combination of Chinese and western medicine treatment of the new law will tell the world now and in the future to help you eliminate respiratory syndrome (MERS) in the Middle East, such as H7N9 subtype avian influenza pandemic caused by RNA viruses such as fear and respiratory syndrome (MERS) in the Middle East, such as H7N9 subtype avian influenza RNA virus prevention and cure measures such as plays this role, for your comment and reference.Respiratory syndrome and H7N9 subtype avian influenza in the Middle East and so on RNA virus is world and cause great harm, severe disease and death cases has increased dramatically. Respiratory syndrome in the Middle East and H7N9 avian flu virus RNA virus is the worlds first discovery of the new RNA viruses, we cannot rule out the Middle East such as respiratory syndrome and H7N9 subtype avian influenza RNA virus infectivity, invasive stronger possibility, we must face up to the limited understanding of the virus for human being and the terrible of the virus. To save people lives and reduce the whole society as soon as possible for the Middle East respiratory syndrome and H7N9 subtype of avian influenza RNA viruses cause diseases such as panic, in order to prevent the present and the future prevention and control of many types of RNA virus pathogenic cause human toes, dedicate to belong to the RNA virus causes acute disease for many years Chinese and western medicine combined with clinical research protocols, for the treatment of respiratory syndrome and avian influenza RNA virus in the Middle East.A, the Middle East, respiratory syndrome, H7N9 subtype avian influenza RNA viruses such as present situation and the severity of the disease1, respiratory syndrome in the Middle East, such as H7N9 subtype avian influenza RNA virus at present although the incidence is not high, but its mortality is taller, deaths from all ages, H7N9 subtype avian influenza, such as the Middle East deaths from respiratory syndrome such as RNA virus pathogenic characteristics of smoking heavily male-dominated and high.2, the Middle East, respiratory syndrome and H7N9 subtype avian influenza RNA virus pathogenic infectious strong (can be transmitted by contact transmission, air, respiratory syndrome in the Middle East and so on in South Korea has been one of the third generation, fourth generation transmission.) , but people, too many people contact with poultry opportunity: interpersonal relations are necessary, flying birds, poultry wildfowl ground running, human beings cannot destroy poultry, the camel is the ships of the desert, animals are many new infectious disease outbreaks.3, respiratory syndrome in the Middle East, such as H7N9 subtype avian influenza RNA virus disease early patients as if its not a feeling, but in 7 to 11 days condition suddenly increased, most patients or respiratory failure, because it is infringement of main parts of the lung, followed by small blood vessels, lung, kidney and other organs, cause lung oxygenation ability is poor, the body much viscera function failure.4, respiratory syndrome in the Middle East, such as H7N9 subtype avian influenza RNA virus disease onset acute and critical condition, the lethal time short, critically ill treatment is difficult.5, there is no specific vaccine against, and no specific kill H7N9 subtype of avian influenza virus and RNA viruses such as respiratory syndrome to the Middle East.6, the Middle East, respiratory syndrome and H7N9 subtype avian influenza RNA virus pathogenic virus belong to RNA viruses, RNA virus vaccine without cross immunity function, such as a/H1N1 flu vaccine for its protection.7 or more were nearly thousand samples in recent years, including H7N9 avian influenza and respiratory syndrome positive samples in the Middle East, including samples of chicken and duck samples and environmental samples, pigeons, camel samples. The uncertainty of the universality of positive samples, birds move extremely harm humans, to know people contact with birds and it has been reported in the terrible disease.8, the human experience in 2009 after the a/H1N1 flu pandemic first panic, look down on this process, to encourage people to H7N9 subtype of avian influenza and respiratory syndrome in the Middle East and so on epidemic prevention and control of paralysis, potential harm that may cause disease.9, currently on bird flu and human respiratory syndrome prevention and control measures is not scientific and the Middle East in the Middle East respiratory syndrome and high lethal H7N9 subtype avian influenza in humans is not scientific and high cost (blind cost a lot of manpower and material resources and financial resources) prevention and treatment of respiratory syndrome in the Middle East and H7N9 subtype of avian influenza infection.10, as the climate changes, the time delay, do not rule out the poisonous force of avian influenza virus and respiratory syndrome virus in the Middle East, aggressivity further enhance or mutation bring greater disaster to human beings. The respiratory syndrome in the Middle East, such as H7N9 subtype avian influenza RNA virus virulence, aggressive may be weaker than the SARS virus.Second, respiratory syndrome and H7N9 subtype avian influenza in the Middle East and so on RNA virus is not terrible1, the Middle East people are infected with respiratory syndrome and H7N9 avian flu virus RNA virus, is the worlds first discovery of new subtype influenza virus.2, respiratory syndrome virus and avian influenza viruses in the Middle East and so on virus belong to RNA viruses are sticky, avian influenza viruses that are sticky virus a/h1n1 flu virus genera. The emergence of human infection H7N9 avian flu virus, the virus virus for new heavy, and its internal genes from H9N2 avian influenza viruses, RNA viruses.3, RNA virus infection for acute transient, mostly self-limiting infectious disease, SARS, h1n1 and seasonal flu virus, Japanese encephalitis virus, hemorrhagic fever virus, measles, mumps virus, human bird flu virus, the Spanish flu virus and so on. Influenza virus and respiratory syndrome in the Middle East and so on virus is transient, self-limiting infectious diseases.4, RNA virus infection were mostly a long-lasting immunity: SARS, swine flu, hemorrhagic fever, mumps, measles, encephalitis b, and so on. RNA virus disease mostly self-limited disease As long as through the onset of crisis, many patients with no special treatment still can recover, avian influenza virus and respiratory syndrome in the Middle East and so on virus disease. Today, only temporary not found HIV RNA virus infection the human body to obtain their own immunity, AIDS can come on over and over again.5, or RNA virus and was observed in most of the bodys immune system to destroy affinity of human tissue cells by the virus: seasonal influenza virus, Japanese encephalitis virus, hemorrhagic fever virus, measles, mumps virus, human bird flu virus, the Spanish flu virus, respiratory syndrome virus in the Middle East and so on. RNA virus or and abnormal immune most for one-time damage tissue cells in the body, only except the AIDS virus, because it is the affinity of T cells, the bodys immune system, so it is repeated damage to the bodys immune system, and the bodys immune system also has no ability to kill it.Most, RNA virus in the short term is the bodys immune system transient failure rather than a disease, repeated over and over again destroyed by human tissue cells: the SARS virus, the H1N1 virus, seasonal influenza viruses, Japanese encephalitis virus, hemorrhagic fever virus, measles, mumps virus, human bird flu virus, the Spanish flu virus, respiratory syndrome virus in the Middle East and so on, they cause the body disease often caused by the disease virus before recovering after check. Only the AIDS virus did not turn.7, most of the RNA virus disease cure does not need specific treatment for RNA virus, just need early pathological physiological changes for treatment can be cured. Like seasonal flu, SARS, hemorrhagic fever, Japanese encephalitis, a/h1n1 flu and so on.8, whatever any influenza virus variation, plus ca change to RNA virus, as long as we do now and in the future early understanding of its pathogenesis, early know its pathological physiology change, early diagnosis of the disease for vulnerable groups by clinical symptoms first, followed by RNA virus detection, early tr