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Human bird flu outbreak: lack of exposure to primary medical problem, such as old
At 15:56 on March 30, 2009 [来说两句me] [Font Size: Xinhuanet]
Source: "Chinese Hospital" magazine Author: Liu Wei Xiu Jinlai
Editor's note: in January this year, before and after our country people confirmed eight cases of bird flu. In 2008, however, total number of reported cases only three cases.
Human avian flu disease outbreak-intensive, so that groups of infectious diseases suddenly serious situation.
As with many infectious diseases, there is the fear of bird flu virus is still unknown from it. "Atypical pneumonia" after the country set up a public health emergency response system, the frequency of bird flu virus attack, and finally there is the opportunity to let the system from paper directly to accept the reality test.
However, in this life to eight patients with final exams for the price of life and death, we found that the original was the emergency system Chao-Gang奉若did not seem the United States, not only failed to resist the brute force approach of avian flu virus, it has been revealed dislocation at the system, such as primary health care of old vacancy problem.
Battle xupu
Health Bureau and the CDC, two of infectious disease reporting system at the requirements and have a dislocation between reality, so that the people溆浦县hospital dilemma.
If it is not because of bird flu, should flower舒荣anonymous work or a sister. Chinese New Year this year happened to go home, let her out of one accident many hats - Human bird flu.
Flower舒荣Xiangxi溆浦县at home, rolling mountains and the people are mixed poultry paradise for generations. There will always nameless chickens and ducks died, the locals used to dying poultry board made of chicken slaughtered in advance pressed salted duck, eat or keep guests.
On the eve of Chinese New Year, Back from Guangzhou Flower舒荣homeland, the village poultry are once again beginning of life and death cycle of her own chickens and ducks have also been involved. In order to avoid all the dead chickens and ducks, she helped kill chickens ducks at home. New Year's Eve, two days before the beginning of flower舒荣fever, by the village barefoot doctor has not improved after treatment, his condition舒荣spend more and more weight, accompanied by their families, the people in the New Year's Day arrived溆浦县hospital.
Unexpected virus
"If the first two days of the morning did not come DENG Hong-hua hospital rounds, the patient was perhaps a missed diagnosis."溆浦县Liu Xiaopeng, vice president of People's Hospital, a lingering fear.
January 26 (New Year's Day) afternoon, the hospital treated up to a temperature of 40.06 ℃ flower舒荣. Liu Xiaopeng knew this day patients, the doctor on duty told him the phone, patients with serious and difficult home, proposed to allow transfers. Liu Xiaopeng did not agree to require a doctor first checks the basic condition to make a decision after the master clear.
舒荣reception flower has two doctors for her to do the routine and chest CT. CT film shows that there is one-third of patients with right lung is changed, there is also left scattered infiltration point - with severe pneumonia, common diseases, because doctors did not particularly care about.
January 27 (the two early) morning to the hospital within two rounds DENG Hong-hua, director of Flower舒荣look at medical records and found a strange phenomenon: the past舒荣Healthy flower, blood does not clear, as with the chest, interleukin value has declined. DENG Hong-hua was aware that it is virus infection.
"The First People's Hospital of Huaihua just a person who died of bird flu patients, the clinical manifestations舒荣flower like the disease, severe, such as low blood and poultry from infected areas, in line with unexplained pneumonia, diagnostic criteria, which are caused by I attach great importance to the main reason. "DENG Hong-hua memory.
Subsequently proved that the DENG Hong-wah on high alert, for the successful treatment舒荣key step in laying a flower. By asking, DENG Hong-hua舒荣flower was found to have a history of exposure to poultry, there is all the more disturbing her mind immediately reported to the medical quality control phone chief Leung Yeung Chau.
Yeung Chau Leung clearly remember the time the call is at 11 o'clock on January 27 many. "I see patients go to the wards and at the same time to report to the Vice-President Liu Xiaopeng." Leung Yeung Chau of "Chinese Hospital" journalist said: "Although people Having never been involved in avian influenza, but I highly doubt that this disease . "
On the eve of Chinese New Year, the Board requested溆浦县area health care institutions each day零报告制度report all diagnosed cases of pneumonia of unknown causes, must be submitted in strict accordance with the provisions, in particular, people should pay attention to avian flu. Hospitals meeting stressed the need to pay attention to cases of pneumonia of unknown causes. Since the outbreak of the hospital Rapporteur vacation, Liu Xiaopeng on the job as temporary. Received a phone when exactly Liu Xiaopeng and Liu County Health Secretary million conversations at work, they immediately reported orally.
Very nervous the next time. 12:00 the same day, the hospital organized a large hospital consultation, the view that the consultation: the diagnosis of severe pneumonia in very clear, consider belong to virus infection, people do not rule out avian influenza, pneumonia of unknown causes in line with the conditions reported. 1 hour later, doctors from the Health Bureau溆浦县shares lead organization governance County People's Hospital, the county and the county hospital of Chinese medicine experts CDC's largest county consultation, consultation findings.
However, the problem out quickly.
According to the procedures, the people溆浦县hospital within two hours in the Chinese Disease Control and Prevention through the information system directly pneumonia of unknown causes at the network's medical history reported to flower舒荣situation, Liu Xiaopeng has a dilemma. "Although the CDC under the Public Health Bureau, but also its own system. The results of consultation, the County CDC CDC immediately reported to the city, the provincial city of CDC CDC also reported phone. Provincial CDC requirements At our 2 hours at straight. But the views of the county health bureau, the first under the Huaihua溆浦县Municipal Health Bureau reported that the request of municipal experts from consultation, if people do not rule out bird flu, and then reported to straight. Administration of the Department of Health to consider many aspects, but the CDC's report, I did not dare go against. "
Health Bureau and the CDC, two of infectious diseases reported to the system with the reality at the wrong leads. This leads to the multi-management issues, so that confusion Liu Xiaopeng.
15:00 the same day, the hospital network in accordance with the requirements of direct reports finish. At this point, the county collected in patients with CDC were car-related specimens sent to the provincial capital Changsha. Health溆浦县put forward at that time, county CDC did not according to plan, submitted too soon, fearing a negative impact on society.
Our source has told,溆浦县Health concerns also received from the stress, "The First People's Hospital of Huaihua recently the case of reception from the people in Guizhou imported cases of avian flu to hospital with severe pneumonia admitted to hospital . Later, in line with the hospital found that patients with the diagnosis of pneumonia of unknown causes, then we have to ask the province of the expert consultation, and reported to the relevant state department. Leaders at all levels, experts come to the hospital an additional workload, from the reception to the death 4 days, the hospital received more than 10 million fee to spend the money.老少边穷region for medical institutions, are spending a small fortune. With the warning, the more inadequate funding for health authorities to溆浦县say, natural to consider their own capacity, hoping to wait until municipal expert opinions issued after more precise Direct Network Report. "
Huaihua City Health Bureau convened the Expert Group was rushed to the emergency xupu. To the way traffic when the city of Huaihua, vice president of First People's Hospital, Department of Respiratory Medicine贻秋Zhang suddenly think of the experts, that the hospital in the rescue of people in Guizhou input of patients with avian flu, the Ministry of Health experts in the treatment of people brought about by the effects of avian flu drug Tamiflu has not yet run out, they immediately ordered the driver make a U-turn, back to Huaihua taking Tamiflu.
Until 6:30 p.m. that day, the Group 3 and his people finally arrive xupu. After consultation, the Group believes that the people溆浦县hospital diagnosis of "well-founded", the diagnosis is still considered a severe viral pneumonia, a high degree of people suspected of bird flu, but the department must wait until the test results superior to the final diagnosis.
Yeung Chau Leung explained that "people because bird flu finally diagnosed the country required the test results issued by CDC, even if there is no diagnosis of Hunan Province right to CDC. The city of the expert group decided to isolate the bird flu in accordance with the treatment of people, brought from the Huaihua preventive medicine Tamiflu has also been applied to patients and nursing staff. "
"The first suspect, the first report, the first treatment, the first referral," the management of a social capital by the creation of county-level public hospitals in the treatment of bird flu person's "4 the most."
The turbulent transfer
"Patients with serious illness, we do not have ICU wards, there is no breathing machine, but there are no special medicines. In accordance with the provisions of Department of Health Administration, critically ill patients should be referred to the three-hospital treatment." Liu Xiaopeng said.
"If bird flu are people, belong to Group B of infectious diseases management, in accordance with the provisions of the spot should be treated in isolation. If the person is not bird flu, the city can receive this one hospital patients, but pre-medical costs 100,000 yuan. "The First People's Hospital of Huaihua insist.
Consultation to discuss at the meeting, the two hospital because a dispute over transfer problem. More difficult is that I heard at another hospital to pay 10 yuan, after lying in the intensive care unit舒荣Flower depression, begin to resist treatment, "not to die."
"Take care of patients with small loss of her mother, grew up and has been out working hard to make a living at home, admitted only 1,000 yuan to pay the money to be spent CT on 270 and there is no ability to renew. If people are not suffering from Avian influenza, severe pneumonia, often hundreds of thousands a few hundred thousand dollars of medical expenses, home can not stand. "DENG Hong-hua was the scene memory.
Costs, about a flower舒荣can achieve transfer. Close to midnight, the two sides are still unable to reach an agreement, decide to wait for test results issued by the provincial CDC after consultation.
Well settled experts, Liu Xiaopeng deep shallow kick back kick to hospital. A few hundred meters of the road, he kept thinking of things to do after dawn: Human bird flu, if not, insist on the transfer; people if the bird flu are on the arrangements of the other two branches of patients with metastasis, and stop receiving new patients .
January 28 (the beginning of the year three), transfer to other hospital patients are busy, the second舒荣flower CT results are in: The right lung is the change from one-third into a two-thirds of the left lung infiltration by point into a sheet, his condition markedly increase. DENG Hong-wah said: "The overall impression is that patients with symptoms and signs do not obviously change, but the results of examination to change very rapidly."
Noon, Hunan CDC reports first results of testing negative, continuing the dignified atmosphere for a long time to relax a bit first. However, the provincial CDC also stressed that for caution's sake, have to wait for second, third test results. Prior to worry because there is no valuable specimens collected from Huaihua City CDC collected samples are being sent to the third way in Changsha. 16:00, Huaihua City Health Bureau and the Government溆浦县xupu at a joint meeting,
City Health Secretary raised the tension out, the Government attaches great importance to pneumonia of unknown causes, not only medical problems to consider, we must also consider the social impact. Regardless of whether patients with avian flu patients who are transferred must do its utmost to treatment.
First off the voice, the silent hall.
Ultimately, the deputy governor of溆浦县position, cost of treatment by the government to advance, but no time 10 million settlement of batches required, Huaihua City, First People's Hospital also, where necessary, agree to receive a flower舒荣. During a meeting of the Hunan province Telephone CDC informed that the second time the test results remain negative, and the atmosphere was relaxed again. Since members of the Group are the backbone of hospital, they run at night after supper Huaihua back.
"Oh, no, it is positive!" 9 o'clock that evening, the third director of the city of CDC CDC received a call from the province, immediately facing the rest of the people are ready said, relaxing atmosphere have been put back again nervous. Tension Phone orders go out immediately on the road at top speed back to the experts. After a moment, then called the Ministry of Health related to the leadership of the phone call will be transferred to patients located in Changsha Xiangya Hospital of Central South University.
January 29 (the beginning of the year four) shortly after midnight, Liu Xiaopeng怀揣him to the county civil affairs bureau 40,000 yuan of medical expenses, led by the people溆浦县hospital medical staff, composed of the best escort team fell Changsha .
No less than the ambulance ride because all the staff, temporary requisition Escort Group Secretary for the county health official cars and an ambulance on the arrangements at the two drivers take turns driving. "City Health Secretary is very concerned about the situation on the road, asked me to call every 1 hour is necessary to report the situation, I do not sleep chant." Liu Xiaopeng excited, more nervous.
"Fortunately, patients can still remain relatively stable body temperature gradually decreased at all the way. Because we found that early and get treatment early, and younger patients with strong resistance, at that time I will definitely be on the estimated cure patients." At the end of the first 7 calls, the escort vehicle group arrived in Changsha, Liu Xiaopeng raised his arm, watch the 7:00 point. Xupu at this time, but also一夜无眠.
达湘雅the hospital, the perianth舒荣specialized in the hospital setting for treatment of human avian influenza wards. Xiangya Hospital spokesman, medical director of mine told Sinorama "Chinese Hospital," in January 2009 because of bird flu person-frequency hair, Xiangya Hospital before the Chinese New Year on the establishment of the relevant expert groups, medical groups, nursing groups and disinfection isolated group, and, in particular, a vacant 50-bed ward, as a ward for treatment of bird flu person.
Xiangya Hospital Consultation Group of Experts found that flower舒荣not only damage the lungs, but also appeared in the liver and heart damage, they used to support therapy for the treatment of organ protection. After 20 days of hospital treatment, the disease gradually舒荣smooth flower until cured.
He carefully explained that "because of economic conditions and limited public awareness of avian flu are very hard to detect at xupu. Our hospital found that the first time, links between the shortest, from the reception to the report, the whole process took less than 24 hours. We, as county hospital had a bit of work to do, at the national medical institutions reported the most junior of them, treatment costs at least spent a total of only 2 million, while some people a case of hospital treatment of patients with avian flu, has to spend more than 100 million million. This is the characteristics of us. "
Sinorama at mine, this hospital from patients with grass-roots be able to recover depends largely on the medical staff able to detect signs of pneumonia of unknown causes, "a clinical diagnosis of early, early use of Tamiflu, which is crucial two points."
Beijing Chaoyang Hospital Respiratory and Critical Care Medicine and ICU, deputy director of Cao Zhi, director of the new experts to the Ministry of Health as part of the flower舒荣treatment, he also supported the opinion Sinorama mine, "to the Xiangya hospital patients, the condition of the patient through the development of the peak temperature started to decline. mainly because of the use of Tamiflu in time by
Verify that the Fe in the control of influenza A virus with the exact efficacy of highly pathogenic avian influenza virus is a type of. "
It appears in Liu Xiaopeng, "xupu experience" is more like a medical emergency system of civil play. "Hospitals are all the equipment before end-of-life products, the glass room is also no money to repair broken state. Departments engaged in contracting, and each section is an interest group, are finished by money." Reform before the people of the county hospital has been run-down to the extreme.
In 2004, the Government will lease to the hospital social capital gradually go back to hospital on the right track of development. "Hospital or public ownership, the case encountered in public health, to bear the same responsibilities and obligations, such as hand, foot and mouth disease, such as Sanlu milk powder incident, the Government does not give us any financial assistance, but we still have to bear the task of screening for medical treatment, resulting all costs must be borne by the hospital on their own. "Liu Xiaopeng had some difficulty," the state does not invest in hospital, the hospital took over the business but also to pay the rental fee, a heavy burden indeed. "
Not cold, Liu Xiaopeng had to edge around the brazier for heating, while small relief to the reporter about the "experience xupu." Out the window at him, an investment by the Government, the 89-storey medical building is the county hospital of Chinese medicine across the sky.
The cause of death mystery
Each home has two similar cases, the final outcome of life is death.
Wen-mei the real cause of death has been controversial in society at annihilation has become a permanent mystery.
Although the death certificate clearly written on the cause of death was "severe pneumonia", but this conclusion was finally PENG Jie Her youngest daughter of the bird flu human to break the truth, including her family, including a lot of people have expressed doubt about its true
Same people are the cause of death of bird flu.
Wen-mei's mother and her daughter if the case is purely a coincidence, then the same happened at both the local Hunan retrospective case, let the original complex suspicions become more complicated and confusing.
In 2006, the 6-year-old Ouyang Shuangtao people have been diagnosed in patients with avian flu, and his mother the same clinical symptoms, in a few days prior to the onset of him died. In 2005, Yao Jun-9-year-old was diagnosed as the first person at that time in patients with avian flu, and his elder sister is also in line with clinical symptoms of bird flu person, him 1 week before the disease eventually died due. However, Ouyang Shuangtao Shiga Yao's mother and sister have not been confirmed human bird flu patients.
Ouyang and Jun-Yao Shuangtao the end of life at Children's Hospital of Hunan Province have been saved, the President told祝益民"Chinese Hospital" reporter, "because the first one home two cases are not left specimens, the lack of direct evidence, until The experts found in every household of the fact that two similar cases, investigation and want to prove that people are animals at the end of the avian-human transmission is person to person or time, it was already too late. "
Wen-mei's death
Wen-mei Although there is no escape from catastrophe, but fortunately, her youngest daughter eventually survived PENG Jie. Because of infected with bird flu virus, small PENG Jie body's immune system becomes vulnerable than ever before, it is easy to suffer from colds, pneumonia and other infectious diseases. She has grown used to these. Now her family is upset, in the past the hospital had saved their unwillingness to continue to provide their own treatment, all treatment costs are borne by their families required.
December 20, 2008, Wen-Mei PENG Jie and small daughter from Xiaoyi city in Shanxi Province in Changsha, Hunan, Chinese New Year back home. The next day, the aunt of small PENG Jie please mother and daughter to eat them, place on the operators in the aunt of the stalls before the chickens and ducks business. On that day, the table on them a complete free-range chicken.
December 30, Wen-mei does not feel comfortable during the day with fever, cough at night, then the people go to hospital for treatment of Changsha County, for a number of easy treatment. When Wen-mei to go to the hospital a second time for treatment, doctors discovered she had severe pulmonary symptoms, with respiratory failure precursor, it suggested that she go directly to the Central South University Xiangya Hospital Emergency watch.
Emergency department at Xiangya Hospital, Wen-mei is still conscious, but also get out of bed activity.
But whose condition had deteriorated rapidly in the observation room to be less than 36 hours for January 7, passed away at noon rush. At this time, her parents and brother had just arrived from the Shanxi Province Changsha Xiangya Hospital is the way to go.
Since no one with children, PENG Jie has been at the rescue with the mother. Peng Jie's grandmother told the media briefing, at Xiangya Hospital, PENG Jie fever symptoms have appeared, but because his mother at the rescue, no one顾得上children, doctors are not aware of disease symptoms at the same time a mother and her daughter, but did not question had a history of exposure to live birds.
Wen-Mei passed away, their families and hospital did not suspect the existence of the treatment problem, he will soon be the corpse cremated. Whether or not family members of the Wen-mei died of bird flu questions people have returned to Shanxi, PENG Jie small after.
January 11, PENG Jie and Grandpa with the grandmother returned to the rural areas of Shanxi. At noon the same day, the 2-year-old girl on a very serious fever, has been to insist afternoon January 14, was rushed to hospital the people Xiaoyi City. Since a serious condition, the hospital recommended the immediate transfer Fenyang hospital, and the hospital did not dare Fenyang receive, directly sent to Taiyuan. In the evening, PENG Jie was Grandpa, grandmother to the Children's Hospital in Taiyuan City.
"After the death of her daughter, my granddaughter quickly help you!" Peng Jie Grandpa's words, so that doctors reception was "very serious problem," Peng Jie's family immediately called his mother to check the medical records. Hospital the same evening will be the organization of expert consultations, a preliminary diagnosis of pneumonia of unknown causes. Ministry of Health received a report of the hospital, but also the organization of expert consultation, for the same diagnosis of pneumonia of unknown causes, people do not rule out SARS and avian flu.
Jan. 15 afternoon, the blood samples sent to CDC National test results for the positive specimen. Two days later, by the Ministry of Health expert group consultation, and ultimately was diagnosed human cases of bird flu, the fourth city the people transferred to hospital.
Taiyuan Fourth People's Hospital is the biggest infectious disease hospital. PENG Jie enabled for the hospital has been closed for 6 years SARS isolation ward. With more than 70 beds are the board room at SARS building built during the emergency, when the last SARS patient discharged from hospital, the patients have not lived.
PENG Jie man was diagnosed with bird flu, she suddenly realized that the family has similar symptoms of Wen-mei is also very likely die of the disease. However, because the lack of sufficient evidence, both sides argued for their own patient, a stalemate.
Xiangya Hospital spokesman, Guang-Hua Lei, director of the Medical Department of the "President of the Chinese hospital," explained, "Wen-mei are at Xiangya hospital because of severe pneumonia, acute respiratory distress syndrome, died of. Hospital expert consultation was organized , report from the perspective of the epidemic is not fully consistent with pneumonia of unknown causes four diagnostic criteria. The first fever, Wen-mei's high temperature at pre-admission, but admission body temperature dropped to 36 ℃; and second, there is pneumonia or acute respiratory distress syndrome (ARDS) study the characteristics of the image, because He is admitted to hospital due to severe pneumonia, and therefore bound to comply with standards; third, to reduce the incidence of early or normal WBC count or lymphocyte reduction, Wen-mei of the January 7 blood do not meet standards; the fourth article, by the norms of antibiotic treatment of 3? 5 days
Significant improvement in progression-free, He has been at the emergency room observation and rescue, from admission to time of death is very short, before the treatment can not judge. "
However, relatives He explained to the hospital do not think so. He told the mother "Chinese Hospital" journalist, Wen-mei as the temperature has been the application of antipyretics cycle fluctuations, but have never heard of expert consultation.
Beijing Chaoyang Hospital Respiratory and Critical Care Medicine Branch, deputy director of ICU and Cao Zhi, director of the new family He read to the original medical records provided by our analysis, patients in the initial treatment should only be used as treatment for common cold, there is no normative way application of antibiotics. Xiangya into the hospital, perhaps in the pathogenesis of the first five days of the time, his condition worsened, more people in line with the law of the incidence of avian influenza, bird flu in general people are at 5 days after onset of illness the most. Xiangya Hospital in accordance with the first routine reports and other circumstances to determine at this time in patients with pneumonia of unknown causes are reported in line with the conditions.
However, Cao Zhi, also admitted that the new, in line with the clinical condition of unexplained pneumonia cases reported is very common, the last reported cases are few and far between. Wen-Mei is a 27-year-old young women, even if have 20 weeks pregnant, in the clinical progress so quickly on the probability of severe pneumonia in very small, then should be a matter of enough importance to the Doctor.
From her disease, epidemiological history, as well as her daughter was diagnosed to analyze the situation, people can not be ruled out bird flu.
Children's Hospital of salvation
Has been for China's National Ministry of Health announced the first case of bird flu in people, Jun-Yao nightmare has come to an end three years.
In October 2005, Jun-Yao sustained high fever, cough, shortness of breath, low blood, due to "bronchopneumonia" was admitted to Children's Hospital of Hunan Province. At that time, Jun-Yao Xiangtan is the homeland of avian flu epidemic, he had the disease before the consumption of bird flu in dead poultry, the hospital is likely to consider him a person suffering from bird flu, and then treated in isolation until recovery.
Jun-Yao thanks to the success of the Hunan Provincial Children's Hospital where he set up the pediatric emergency transport system. This system for all children's diseases, and as long as the conditions change quickly, critically ill children across the province to pass through the operation of the transit system to the provincial children's hospital, including infectious diseases.
Say祝益民memory, Jun-Yao transit through the pre-hospital system from Xiangtan City transit through the Maternal and Child Health Hospital, which is key to the success of treatment. If this system did not, even children with their families requested transfer speed will not soon; if the system of children with a lack of professional support, children with their families requested transfer would not make a prompt decision.
祝益民still feel regret, Jun-yao, when the incidence of the Sisters of the clinical manifestations and is very similar to the avian flu has yet to have the opportunity to receive effective treatment, then at Shiga Yao a few days prior to the onset of death.
Two months later, Children's Hospital has treated the first two cases of bird flu in people Shuangtao Ouyang. Prior to this, small Ouyang in Guiyang local health room, hospital and the people in Guiyang County, Chenzhou City Second People's Hospital for treatment, has been around for two weeks, the last human bird flu was confirmed. Changsha, Chenzhou transfer from the small body has been weakened Ouyang, widely infiltrating the lungs, chest almost a "white lung" of the changes in body organs were seriously damaged. Parents turn to the road, does not have any hope.
Hospital did not give up the treatment, feel that the success of the Example No. 1, the first two cases must also be successful. Hospital 44 days after the rescue of the relay, in the capture of a storm after another, and finally put online a small Ouyang pulled from the dead back.
Before the onset of small Ouyang also lost a loved ones, his mother suffered from the symptoms of a disease the same as him, and finally died. Jun-Yao, whether the elder sister of the mother or small Ouyang, because hospital had not been reported to reception, so people were not included in the list of bird flu, the deaths of two people to open the mystery of bird flu has been added to both mystery .
祝益民said: "I think the key is early detection, early intervention, must be the overall co-ordination of the emergency system, emphasize not only medical, but also rely heavily on management. Human bird flu patients and the general requirements of critically ill patients do not like to save the need to set up a special the treatment group treated in isolation. medical personnel for treatment of human bird flu there is no clinical experience, to explore the need for a process can only take full advantage of patients, treatment programs at any time. "
Ouyang did not give a small hospital medicine Tamiflu use. Treatment at the time, experts believe that the virus of the body damage is a very complex pathophysiological process, not one can be completely cut off the drugs and side effects of Tamiflu for children can not be expected that the extent of its effects has yet to be proved.
祝益民explained that the role of all the virus to the human body, arguments are similar. Normal treatment of critically ill patients, clinical manifestations are in fact the whole body Sequential multiple organ damage, treatment of individual organs are to support and protect the most important consideration is to support the treatment of the pathogens are subjected to the protection of good organ damage, which is stabilize the patient's condition and where the key to success.
Experts told reporters that because of taking into account the patients infected with the pathogen, the cause of the inflammatory response in various organs, organ damage are the most important reasons, so the hospital from the latest anti-inflammatory treatment at the time the idea to use low-dose corticosteroids, in the course of treatment, when to replace high-dose treatment of SARS, the impact of short-course therapy. After summing up the two cases where children experience the application of this therapy be considered a very important success factors.
Embarrassing supporting disease control
CDC - Disease Control Department - Deputy Director in charge of the hospital - Bureau of Medical Affairs - Deputy Director in charge of the parallel system, the disease control and clinical artificially separated.
"Discovered late, severe, progress rapidly, the high mortality rate," Department of Health and Human avian flu has not changed over the years to describe the characteristics. National disease control in the current system, medical institutions are identified and controlled an important role in the spread of the epidemic, but the actual operation, it has been marginalized in the system has become awkward to deal with a supporting role in disease control.
Clinical prevention and control of irregular
"Whether or not be able to find early, mainly depends on the clinician's vigilance against infectious diseases." Beijing Chaoyang Hospital Respiratory and Critical Care Medicine Branch, deputy director of ICU and Cao Zhi, director of the new view, of bird flu although people still large sample of accumulated experience, but found that it is not difficult to level due to the limitations of medical institutions.
Cao Zhi, the new has taken part in more than 10 celebrity treatment in patients with avian flu. He told reporters that the incidence of avian influenza virus people after about five days, are in a critical condition, the time came to a standstill node. Prior to this, medical institutions and timely screening of cases, the application as soon as possible effects of drug Tamiflu, the key to the success of treatment.
The early people of avian flu, it is easy to be primary health care institutions as a common cold, pneumonia treatment. Has been confirmed in 38 cases of bird flu among people, the first consultation at the grassroots level in patients with medical institutions accounted for 61.8 percent of the total number, of which only a grassroots medical institutions for patients with suspicious and reported. (See Figure 1)
At present, people suspected bird flu patients to rely largely on screening "SARS" set up after the pneumonia of unknown causes at Direct Network system, which has been extended to the township hospitals. "Has been a period of time there is no SARS, and other clusters of respiratory infections occurred only in the current theory of inference, the straight pneumonia of unknown causes at the current system is primarily aimed at screening people prepare for bird flu." Cao Zhi, the new express.
"Clinicians want to pneumonia of unknown causes based on the criteria, do not need high-end medical equipment, medical institutions have as long as blood tests, chest X-ray film's ability to be able to." According to Cao Zhi, a new experience, often encountered in clinical practice will be consistent with the diagnosis of unexplained pneumonia patients, from screening to the minimal number of people in patients with avian flu, it is easy to make doctors into "all-or-none" dilemma, or are reported as suspected cases, or are given to rule out the possibility. Facts have proved that the doctor's vigilance in the prevention and control of avian influenza does play a role in trigger bodies, once a suspect, almost does not appear to be suspected in patients with misdiagnosis of the situation.
The grass-roots level the role of the first doctors in a number of unexplained disease group was found significantly more performance. Happened in 2008 in violation of the formula to add melamine caused kidney stones in infants are not part of infectious disease, nor did the network have been targeted at the system. It depends on the doctors found a number of major cases at the same time the same symptoms at the time of abnormal sensitivity to grass-roots awareness of medical staff demanding disease control.
"If we only rely on the awareness of primary care doctors for the disease control group of disease prevention and control, disease control at the grassroots level of a state of spontaneous, apparently is not enough. Is more important is to establish a set of standards, with guidance the rules. "relevant person in charge of Hunan Province, said CDC.
However, Huaxi Hospital, Sichuan University, Shi Yingkang introduction, at present, deal with mass flow of disease at medical institutions, particularly primary health care institutions are more chaotic. "For the prevention and control of infectious diseases of statutory law, step-by-step, but when faced with some not clearly defined how to deal with emergencies, medical institutions will be at a loss. Wenchuan earthquake such as at my house the first to discover the wounded gas gangrene both belong to potent infectious diseases, but also belong to the scope of nosocomial infection, we had no choice but to report both the disease control department, and the report of the medical affairs department. taking into account the reported gas gangrene of the greatest significance is the same brother treated the wounded seismic alert medical institutions , went to inform other medical institutions. This fuzzy rules on the same group is not conducive to the discovery and reporting of disease. "
Disease control in order to make up our country the existing grass-roots short board, March 10, from Beijing University School of Public Health to assume the "community of fever and diarrhea symptoms for early identification and early warning technology research," the official opening title. Against infectious diseases subject to the two most common symptoms - fever and diarrhea in the community health service centers, primary health care institutions to monitor the disease groups, the scientific feasibility of the design rules. At present, the subject has been incorporated into the National High-tech Research and Development Program (863 Program) thematic issues, is scheduled to finish in 2011 and the overall design flow.
President of the Peking University School of Public Health HU Yong-hua believes that "for all groups of unknown causes of disease prevention and control is still necessary to implement community-based prevention and control of medical institutions with a combination of the first consultation. The disease control which requires the community clinician should have basic skills, clinicians should have a basic awareness of prevention and control of infectious diseases. the knowledge of the structure of the two complement each other, common in the rule of law, regulations, guidelines, under the guidance of disease control constitute a grass-roots network, is the ideal status.
Separate the two sets of system
"Township hospitals experienced fever, General situation of poor patients, many patients would recommend the higher level hospitals.
"A person in charge of township hospitals told the reporter, even with blood tests and chest X-ray pictures of the equipment, they would not have to stay patient不愈by the administration in patients with pneumonia." Medical conditions are the main reason, followed have economic considerations, a series of rescue and other costs, we can not advance. "
Even if the medical institutions at or above the county level, of pneumonia of unknown causes hesitates is reported.溆浦县Liu Xiaopeng, vice president of People's Hospital told reporters, "If confirmed true human bird flu, of course, should be reported to hospital, but if the bird flu is not a person, will give the hospital administration or local health department brought many problems."
SHI Ying-kang said that in the normal, disease control and monitoring of education on the existence of the multi-management, CDC, public health administration department of disease control, as well as medical affairs department in the department to do a similar thing. If it is found and reported problem, it will involve all aspects. It is within the hospital medical information system has been excluded from the country's disease control network.
"Groups of unknown causes at the discovery and treatment of disease, the CDC and the hospital is the relationship between each other, subject to health administrative departments at the same time the unity of the deployment. At present, the country placed too much emphasis on disease control department of a leading role, will be the main energy and one of funding, to the neglect of health care institutions in the role of disease control, and then the cart before the horse. "祝益民president of the Hunan Provincial Children's Hospital believe that the CDC should be the strong support of medical institutions, health administration at the same
Department under the leadership of medical institutions to help achieve disease control mission. If the formation of hospital-led disease control system, can save a lot of intermediate links, to reduce the cost of communication department.
"Human bird flu on the run, found that in patients with clinical, clinical treatment, the more also depends on the clinical."祝益民think, clinical medical institutions and professional bodies for Disease Control CDC's role is equally important, not affiliation Today, it has been artificially marginalized.
"State funds allocated for disease control than the grass-roots level, monitoring is also less than the grass-roots level to implement, and the Doctor of clinical disease control at the grassroots level education is more the more weak, resulting in grassroots medical institutions engaged in disease control depends on work experience and ethics, the effect of natural discount . "Liu Xiaopeng also deep.
HU Yong-hua said that "after the SARS, China's disease control in the establishment of a new system, when not deliberately divided and clinical prevention. While trying to pinch the two together, but no good pinch."
Shi Yingkang also believes that the current CDC - Disease Control Department - Deputy Director in charge of the hospital - Bureau of Medical Affairs - Deputy Director in charge of the parallel system, the disease control and clinical artificially separated. Both in prevention and control of infectious diseases, or deal with unexpected events, and even construction of information network connection, there are a lot of questions. "Not as good as the division of disease control from the administration to go on to manage the medical affairs department, the following specific and up to now has been the implementation of sophisticated health care system, while improving the relevant laws,
Regulations and technical specifications. The only way to achieve cost-effective disease prevention and control. "
"Health care organizations can be hard to do disease control, but also depends on the country on whether the hospital in place of compensation." At HU Yong-hua, the last century 90's will market medical institutions and medical institutions to make disease control requirements, is itself a perverse theory, "even though the hospital does not want to declare, but do not consider professional ethics, simply from the operator's perspective, prevention is certainly moving in the opposite direction can not be combined."
Legal difficulties
Hunan Provincial Department of Health Emergency Response Office of the Pang and then think, "man's awareness of the disease are known from the unknown to the process, in the process, must pay a price. We have to do is to shorten this from the unknown to the known process, to put a minimum price, which required the support of scientific research. "
Ministry of Health has issued a "people bird flu clinic program" (hereinafter referred to as "treatment program") for the guidance of medical institutions, the current version has been updated to 2008. "The Ministry of Health clinic program of organization are the experts, according to information provided by the World Health Organization, to draw people around the world where the experience of patients with avian flu prepared." Cao Zhi, a new introduction for the people of our country there bird flu, the Ministry of Health received at the first patient case report, will be reported directly through the network system to obtain relevant information on the patient for analysis, confirmed at the same time, it will be effective and informative programs to the clinic. However, after the diagnosis of patients with clinical experience, have not updated in time.
A lot of courage to participate in the grass-roots level where the bird flu medical staff believe that the only treatment program of guidance, refer to the actual operation of little significance.
"For the academic aspects of the disease groups, a summary of my country to do very well, lost a lot of valuable experience." HU Yong-hua of the view that the clinical experience of an unknown infectious disease summary, the system required the joint efforts of experts, including experts in epidemiology, basic medical experts, clinical experts, or even in statistics, sociology experts also involved. During SARS, our country is very rich information on the case, but because no one organization to conduct in-depth research, no development on a lot of information lost in vain.
Due to institutional constraints, the relevant laws and regulations and technical specifications of the perfect HU Yong-hua has become the most important solution to the problem. In his view, the emphasis in our country has been one case, three systems (plans and mechanisms, institutions, the rule of law), the rule of law are fundamental. "SARS raid so that we have learned a useful skill - plans to do. Even though a lot of plans in real time applications, was found to be not practical, but at least we have a good start. China's disease prevention and control, but also stop relying on the existing system, the phase of the implementation of the rule of man.
The rule of man to the rule of law from a very necessary process, but improve the relevant laws, regulations and technical specifications, has always been the direction of our efforts should be made. "
According to him, in 2008, "General Hospital infectious disease management to evaluate the content of norms and standards" of the research work at Peking University School of Public Health started, the purpose is to clarify the General groups of medical institutions in case of disease and injury in the duty , as well as the realization of the path of duty. Other specialty hospitals, health care, the prevention and treatment by institutions such as the formulation of the relevant norms are also planned. Disease control system of the existence of separate systems, may be another way to gradually bridge.
At 15:56 on March 30, 2009 [来说两句me] [Font Size: Xinhuanet]
Source: "Chinese Hospital" magazine Author: Liu Wei Xiu Jinlai
Editor's note: in January this year, before and after our country people confirmed eight cases of bird flu. In 2008, however, total number of reported cases only three cases.
Human avian flu disease outbreak-intensive, so that groups of infectious diseases suddenly serious situation.
As with many infectious diseases, there is the fear of bird flu virus is still unknown from it. "Atypical pneumonia" after the country set up a public health emergency response system, the frequency of bird flu virus attack, and finally there is the opportunity to let the system from paper directly to accept the reality test.
However, in this life to eight patients with final exams for the price of life and death, we found that the original was the emergency system Chao-Gang奉若did not seem the United States, not only failed to resist the brute force approach of avian flu virus, it has been revealed dislocation at the system, such as primary health care of old vacancy problem.
Battle xupu
Health Bureau and the CDC, two of infectious disease reporting system at the requirements and have a dislocation between reality, so that the people溆浦县hospital dilemma.
If it is not because of bird flu, should flower舒荣anonymous work or a sister. Chinese New Year this year happened to go home, let her out of one accident many hats - Human bird flu.
Flower舒荣Xiangxi溆浦县at home, rolling mountains and the people are mixed poultry paradise for generations. There will always nameless chickens and ducks died, the locals used to dying poultry board made of chicken slaughtered in advance pressed salted duck, eat or keep guests.
On the eve of Chinese New Year, Back from Guangzhou Flower舒荣homeland, the village poultry are once again beginning of life and death cycle of her own chickens and ducks have also been involved. In order to avoid all the dead chickens and ducks, she helped kill chickens ducks at home. New Year's Eve, two days before the beginning of flower舒荣fever, by the village barefoot doctor has not improved after treatment, his condition舒荣spend more and more weight, accompanied by their families, the people in the New Year's Day arrived溆浦县hospital.
Unexpected virus
"If the first two days of the morning did not come DENG Hong-hua hospital rounds, the patient was perhaps a missed diagnosis."溆浦县Liu Xiaopeng, vice president of People's Hospital, a lingering fear.
January 26 (New Year's Day) afternoon, the hospital treated up to a temperature of 40.06 ℃ flower舒荣. Liu Xiaopeng knew this day patients, the doctor on duty told him the phone, patients with serious and difficult home, proposed to allow transfers. Liu Xiaopeng did not agree to require a doctor first checks the basic condition to make a decision after the master clear.
舒荣reception flower has two doctors for her to do the routine and chest CT. CT film shows that there is one-third of patients with right lung is changed, there is also left scattered infiltration point - with severe pneumonia, common diseases, because doctors did not particularly care about.
January 27 (the two early) morning to the hospital within two rounds DENG Hong-hua, director of Flower舒荣look at medical records and found a strange phenomenon: the past舒荣Healthy flower, blood does not clear, as with the chest, interleukin value has declined. DENG Hong-hua was aware that it is virus infection.
"The First People's Hospital of Huaihua just a person who died of bird flu patients, the clinical manifestations舒荣flower like the disease, severe, such as low blood and poultry from infected areas, in line with unexplained pneumonia, diagnostic criteria, which are caused by I attach great importance to the main reason. "DENG Hong-hua memory.
Subsequently proved that the DENG Hong-wah on high alert, for the successful treatment舒荣key step in laying a flower. By asking, DENG Hong-hua舒荣flower was found to have a history of exposure to poultry, there is all the more disturbing her mind immediately reported to the medical quality control phone chief Leung Yeung Chau.
Yeung Chau Leung clearly remember the time the call is at 11 o'clock on January 27 many. "I see patients go to the wards and at the same time to report to the Vice-President Liu Xiaopeng." Leung Yeung Chau of "Chinese Hospital" journalist said: "Although people Having never been involved in avian influenza, but I highly doubt that this disease . "
On the eve of Chinese New Year, the Board requested溆浦县area health care institutions each day零报告制度report all diagnosed cases of pneumonia of unknown causes, must be submitted in strict accordance with the provisions, in particular, people should pay attention to avian flu. Hospitals meeting stressed the need to pay attention to cases of pneumonia of unknown causes. Since the outbreak of the hospital Rapporteur vacation, Liu Xiaopeng on the job as temporary. Received a phone when exactly Liu Xiaopeng and Liu County Health Secretary million conversations at work, they immediately reported orally.
Very nervous the next time. 12:00 the same day, the hospital organized a large hospital consultation, the view that the consultation: the diagnosis of severe pneumonia in very clear, consider belong to virus infection, people do not rule out avian influenza, pneumonia of unknown causes in line with the conditions reported. 1 hour later, doctors from the Health Bureau溆浦县shares lead organization governance County People's Hospital, the county and the county hospital of Chinese medicine experts CDC's largest county consultation, consultation findings.
However, the problem out quickly.
According to the procedures, the people溆浦县hospital within two hours in the Chinese Disease Control and Prevention through the information system directly pneumonia of unknown causes at the network's medical history reported to flower舒荣situation, Liu Xiaopeng has a dilemma. "Although the CDC under the Public Health Bureau, but also its own system. The results of consultation, the County CDC CDC immediately reported to the city, the provincial city of CDC CDC also reported phone. Provincial CDC requirements At our 2 hours at straight. But the views of the county health bureau, the first under the Huaihua溆浦县Municipal Health Bureau reported that the request of municipal experts from consultation, if people do not rule out bird flu, and then reported to straight. Administration of the Department of Health to consider many aspects, but the CDC's report, I did not dare go against. "
Health Bureau and the CDC, two of infectious diseases reported to the system with the reality at the wrong leads. This leads to the multi-management issues, so that confusion Liu Xiaopeng.
15:00 the same day, the hospital network in accordance with the requirements of direct reports finish. At this point, the county collected in patients with CDC were car-related specimens sent to the provincial capital Changsha. Health溆浦县put forward at that time, county CDC did not according to plan, submitted too soon, fearing a negative impact on society.
Our source has told,溆浦县Health concerns also received from the stress, "The First People's Hospital of Huaihua recently the case of reception from the people in Guizhou imported cases of avian flu to hospital with severe pneumonia admitted to hospital . Later, in line with the hospital found that patients with the diagnosis of pneumonia of unknown causes, then we have to ask the province of the expert consultation, and reported to the relevant state department. Leaders at all levels, experts come to the hospital an additional workload, from the reception to the death 4 days, the hospital received more than 10 million fee to spend the money.老少边穷region for medical institutions, are spending a small fortune. With the warning, the more inadequate funding for health authorities to溆浦县say, natural to consider their own capacity, hoping to wait until municipal expert opinions issued after more precise Direct Network Report. "
Huaihua City Health Bureau convened the Expert Group was rushed to the emergency xupu. To the way traffic when the city of Huaihua, vice president of First People's Hospital, Department of Respiratory Medicine贻秋Zhang suddenly think of the experts, that the hospital in the rescue of people in Guizhou input of patients with avian flu, the Ministry of Health experts in the treatment of people brought about by the effects of avian flu drug Tamiflu has not yet run out, they immediately ordered the driver make a U-turn, back to Huaihua taking Tamiflu.
Until 6:30 p.m. that day, the Group 3 and his people finally arrive xupu. After consultation, the Group believes that the people溆浦县hospital diagnosis of "well-founded", the diagnosis is still considered a severe viral pneumonia, a high degree of people suspected of bird flu, but the department must wait until the test results superior to the final diagnosis.
Yeung Chau Leung explained that "people because bird flu finally diagnosed the country required the test results issued by CDC, even if there is no diagnosis of Hunan Province right to CDC. The city of the expert group decided to isolate the bird flu in accordance with the treatment of people, brought from the Huaihua preventive medicine Tamiflu has also been applied to patients and nursing staff. "
"The first suspect, the first report, the first treatment, the first referral," the management of a social capital by the creation of county-level public hospitals in the treatment of bird flu person's "4 the most."
The turbulent transfer
"Patients with serious illness, we do not have ICU wards, there is no breathing machine, but there are no special medicines. In accordance with the provisions of Department of Health Administration, critically ill patients should be referred to the three-hospital treatment." Liu Xiaopeng said.
"If bird flu are people, belong to Group B of infectious diseases management, in accordance with the provisions of the spot should be treated in isolation. If the person is not bird flu, the city can receive this one hospital patients, but pre-medical costs 100,000 yuan. "The First People's Hospital of Huaihua insist.
Consultation to discuss at the meeting, the two hospital because a dispute over transfer problem. More difficult is that I heard at another hospital to pay 10 yuan, after lying in the intensive care unit舒荣Flower depression, begin to resist treatment, "not to die."
"Take care of patients with small loss of her mother, grew up and has been out working hard to make a living at home, admitted only 1,000 yuan to pay the money to be spent CT on 270 and there is no ability to renew. If people are not suffering from Avian influenza, severe pneumonia, often hundreds of thousands a few hundred thousand dollars of medical expenses, home can not stand. "DENG Hong-hua was the scene memory.
Costs, about a flower舒荣can achieve transfer. Close to midnight, the two sides are still unable to reach an agreement, decide to wait for test results issued by the provincial CDC after consultation.
Well settled experts, Liu Xiaopeng deep shallow kick back kick to hospital. A few hundred meters of the road, he kept thinking of things to do after dawn: Human bird flu, if not, insist on the transfer; people if the bird flu are on the arrangements of the other two branches of patients with metastasis, and stop receiving new patients .
January 28 (the beginning of the year three), transfer to other hospital patients are busy, the second舒荣flower CT results are in: The right lung is the change from one-third into a two-thirds of the left lung infiltration by point into a sheet, his condition markedly increase. DENG Hong-wah said: "The overall impression is that patients with symptoms and signs do not obviously change, but the results of examination to change very rapidly."
Noon, Hunan CDC reports first results of testing negative, continuing the dignified atmosphere for a long time to relax a bit first. However, the provincial CDC also stressed that for caution's sake, have to wait for second, third test results. Prior to worry because there is no valuable specimens collected from Huaihua City CDC collected samples are being sent to the third way in Changsha. 16:00, Huaihua City Health Bureau and the Government溆浦县xupu at a joint meeting,
City Health Secretary raised the tension out, the Government attaches great importance to pneumonia of unknown causes, not only medical problems to consider, we must also consider the social impact. Regardless of whether patients with avian flu patients who are transferred must do its utmost to treatment.
First off the voice, the silent hall.
Ultimately, the deputy governor of溆浦县position, cost of treatment by the government to advance, but no time 10 million settlement of batches required, Huaihua City, First People's Hospital also, where necessary, agree to receive a flower舒荣. During a meeting of the Hunan province Telephone CDC informed that the second time the test results remain negative, and the atmosphere was relaxed again. Since members of the Group are the backbone of hospital, they run at night after supper Huaihua back.
"Oh, no, it is positive!" 9 o'clock that evening, the third director of the city of CDC CDC received a call from the province, immediately facing the rest of the people are ready said, relaxing atmosphere have been put back again nervous. Tension Phone orders go out immediately on the road at top speed back to the experts. After a moment, then called the Ministry of Health related to the leadership of the phone call will be transferred to patients located in Changsha Xiangya Hospital of Central South University.
January 29 (the beginning of the year four) shortly after midnight, Liu Xiaopeng怀揣him to the county civil affairs bureau 40,000 yuan of medical expenses, led by the people溆浦县hospital medical staff, composed of the best escort team fell Changsha .
No less than the ambulance ride because all the staff, temporary requisition Escort Group Secretary for the county health official cars and an ambulance on the arrangements at the two drivers take turns driving. "City Health Secretary is very concerned about the situation on the road, asked me to call every 1 hour is necessary to report the situation, I do not sleep chant." Liu Xiaopeng excited, more nervous.
"Fortunately, patients can still remain relatively stable body temperature gradually decreased at all the way. Because we found that early and get treatment early, and younger patients with strong resistance, at that time I will definitely be on the estimated cure patients." At the end of the first 7 calls, the escort vehicle group arrived in Changsha, Liu Xiaopeng raised his arm, watch the 7:00 point. Xupu at this time, but also一夜无眠.
达湘雅the hospital, the perianth舒荣specialized in the hospital setting for treatment of human avian influenza wards. Xiangya Hospital spokesman, medical director of mine told Sinorama "Chinese Hospital," in January 2009 because of bird flu person-frequency hair, Xiangya Hospital before the Chinese New Year on the establishment of the relevant expert groups, medical groups, nursing groups and disinfection isolated group, and, in particular, a vacant 50-bed ward, as a ward for treatment of bird flu person.
Xiangya Hospital Consultation Group of Experts found that flower舒荣not only damage the lungs, but also appeared in the liver and heart damage, they used to support therapy for the treatment of organ protection. After 20 days of hospital treatment, the disease gradually舒荣smooth flower until cured.
He carefully explained that "because of economic conditions and limited public awareness of avian flu are very hard to detect at xupu. Our hospital found that the first time, links between the shortest, from the reception to the report, the whole process took less than 24 hours. We, as county hospital had a bit of work to do, at the national medical institutions reported the most junior of them, treatment costs at least spent a total of only 2 million, while some people a case of hospital treatment of patients with avian flu, has to spend more than 100 million million. This is the characteristics of us. "
Sinorama at mine, this hospital from patients with grass-roots be able to recover depends largely on the medical staff able to detect signs of pneumonia of unknown causes, "a clinical diagnosis of early, early use of Tamiflu, which is crucial two points."
Beijing Chaoyang Hospital Respiratory and Critical Care Medicine and ICU, deputy director of Cao Zhi, director of the new experts to the Ministry of Health as part of the flower舒荣treatment, he also supported the opinion Sinorama mine, "to the Xiangya hospital patients, the condition of the patient through the development of the peak temperature started to decline. mainly because of the use of Tamiflu in time by
Verify that the Fe in the control of influenza A virus with the exact efficacy of highly pathogenic avian influenza virus is a type of. "
It appears in Liu Xiaopeng, "xupu experience" is more like a medical emergency system of civil play. "Hospitals are all the equipment before end-of-life products, the glass room is also no money to repair broken state. Departments engaged in contracting, and each section is an interest group, are finished by money." Reform before the people of the county hospital has been run-down to the extreme.
In 2004, the Government will lease to the hospital social capital gradually go back to hospital on the right track of development. "Hospital or public ownership, the case encountered in public health, to bear the same responsibilities and obligations, such as hand, foot and mouth disease, such as Sanlu milk powder incident, the Government does not give us any financial assistance, but we still have to bear the task of screening for medical treatment, resulting all costs must be borne by the hospital on their own. "Liu Xiaopeng had some difficulty," the state does not invest in hospital, the hospital took over the business but also to pay the rental fee, a heavy burden indeed. "
Not cold, Liu Xiaopeng had to edge around the brazier for heating, while small relief to the reporter about the "experience xupu." Out the window at him, an investment by the Government, the 89-storey medical building is the county hospital of Chinese medicine across the sky.
The cause of death mystery
Each home has two similar cases, the final outcome of life is death.
Wen-mei the real cause of death has been controversial in society at annihilation has become a permanent mystery.
Although the death certificate clearly written on the cause of death was "severe pneumonia", but this conclusion was finally PENG Jie Her youngest daughter of the bird flu human to break the truth, including her family, including a lot of people have expressed doubt about its true
Same people are the cause of death of bird flu.
Wen-mei's mother and her daughter if the case is purely a coincidence, then the same happened at both the local Hunan retrospective case, let the original complex suspicions become more complicated and confusing.
In 2006, the 6-year-old Ouyang Shuangtao people have been diagnosed in patients with avian flu, and his mother the same clinical symptoms, in a few days prior to the onset of him died. In 2005, Yao Jun-9-year-old was diagnosed as the first person at that time in patients with avian flu, and his elder sister is also in line with clinical symptoms of bird flu person, him 1 week before the disease eventually died due. However, Ouyang Shuangtao Shiga Yao's mother and sister have not been confirmed human bird flu patients.
Ouyang and Jun-Yao Shuangtao the end of life at Children's Hospital of Hunan Province have been saved, the President told祝益民"Chinese Hospital" reporter, "because the first one home two cases are not left specimens, the lack of direct evidence, until The experts found in every household of the fact that two similar cases, investigation and want to prove that people are animals at the end of the avian-human transmission is person to person or time, it was already too late. "
Wen-mei's death
Wen-mei Although there is no escape from catastrophe, but fortunately, her youngest daughter eventually survived PENG Jie. Because of infected with bird flu virus, small PENG Jie body's immune system becomes vulnerable than ever before, it is easy to suffer from colds, pneumonia and other infectious diseases. She has grown used to these. Now her family is upset, in the past the hospital had saved their unwillingness to continue to provide their own treatment, all treatment costs are borne by their families required.
December 20, 2008, Wen-Mei PENG Jie and small daughter from Xiaoyi city in Shanxi Province in Changsha, Hunan, Chinese New Year back home. The next day, the aunt of small PENG Jie please mother and daughter to eat them, place on the operators in the aunt of the stalls before the chickens and ducks business. On that day, the table on them a complete free-range chicken.
December 30, Wen-mei does not feel comfortable during the day with fever, cough at night, then the people go to hospital for treatment of Changsha County, for a number of easy treatment. When Wen-mei to go to the hospital a second time for treatment, doctors discovered she had severe pulmonary symptoms, with respiratory failure precursor, it suggested that she go directly to the Central South University Xiangya Hospital Emergency watch.
Emergency department at Xiangya Hospital, Wen-mei is still conscious, but also get out of bed activity.
But whose condition had deteriorated rapidly in the observation room to be less than 36 hours for January 7, passed away at noon rush. At this time, her parents and brother had just arrived from the Shanxi Province Changsha Xiangya Hospital is the way to go.
Since no one with children, PENG Jie has been at the rescue with the mother. Peng Jie's grandmother told the media briefing, at Xiangya Hospital, PENG Jie fever symptoms have appeared, but because his mother at the rescue, no one顾得上children, doctors are not aware of disease symptoms at the same time a mother and her daughter, but did not question had a history of exposure to live birds.
Wen-Mei passed away, their families and hospital did not suspect the existence of the treatment problem, he will soon be the corpse cremated. Whether or not family members of the Wen-mei died of bird flu questions people have returned to Shanxi, PENG Jie small after.
January 11, PENG Jie and Grandpa with the grandmother returned to the rural areas of Shanxi. At noon the same day, the 2-year-old girl on a very serious fever, has been to insist afternoon January 14, was rushed to hospital the people Xiaoyi City. Since a serious condition, the hospital recommended the immediate transfer Fenyang hospital, and the hospital did not dare Fenyang receive, directly sent to Taiyuan. In the evening, PENG Jie was Grandpa, grandmother to the Children's Hospital in Taiyuan City.
"After the death of her daughter, my granddaughter quickly help you!" Peng Jie Grandpa's words, so that doctors reception was "very serious problem," Peng Jie's family immediately called his mother to check the medical records. Hospital the same evening will be the organization of expert consultations, a preliminary diagnosis of pneumonia of unknown causes. Ministry of Health received a report of the hospital, but also the organization of expert consultation, for the same diagnosis of pneumonia of unknown causes, people do not rule out SARS and avian flu.
Jan. 15 afternoon, the blood samples sent to CDC National test results for the positive specimen. Two days later, by the Ministry of Health expert group consultation, and ultimately was diagnosed human cases of bird flu, the fourth city the people transferred to hospital.
Taiyuan Fourth People's Hospital is the biggest infectious disease hospital. PENG Jie enabled for the hospital has been closed for 6 years SARS isolation ward. With more than 70 beds are the board room at SARS building built during the emergency, when the last SARS patient discharged from hospital, the patients have not lived.
PENG Jie man was diagnosed with bird flu, she suddenly realized that the family has similar symptoms of Wen-mei is also very likely die of the disease. However, because the lack of sufficient evidence, both sides argued for their own patient, a stalemate.
Xiangya Hospital spokesman, Guang-Hua Lei, director of the Medical Department of the "President of the Chinese hospital," explained, "Wen-mei are at Xiangya hospital because of severe pneumonia, acute respiratory distress syndrome, died of. Hospital expert consultation was organized , report from the perspective of the epidemic is not fully consistent with pneumonia of unknown causes four diagnostic criteria. The first fever, Wen-mei's high temperature at pre-admission, but admission body temperature dropped to 36 ℃; and second, there is pneumonia or acute respiratory distress syndrome (ARDS) study the characteristics of the image, because He is admitted to hospital due to severe pneumonia, and therefore bound to comply with standards; third, to reduce the incidence of early or normal WBC count or lymphocyte reduction, Wen-mei of the January 7 blood do not meet standards; the fourth article, by the norms of antibiotic treatment of 3? 5 days
Significant improvement in progression-free, He has been at the emergency room observation and rescue, from admission to time of death is very short, before the treatment can not judge. "
However, relatives He explained to the hospital do not think so. He told the mother "Chinese Hospital" journalist, Wen-mei as the temperature has been the application of antipyretics cycle fluctuations, but have never heard of expert consultation.
Beijing Chaoyang Hospital Respiratory and Critical Care Medicine Branch, deputy director of ICU and Cao Zhi, director of the new family He read to the original medical records provided by our analysis, patients in the initial treatment should only be used as treatment for common cold, there is no normative way application of antibiotics. Xiangya into the hospital, perhaps in the pathogenesis of the first five days of the time, his condition worsened, more people in line with the law of the incidence of avian influenza, bird flu in general people are at 5 days after onset of illness the most. Xiangya Hospital in accordance with the first routine reports and other circumstances to determine at this time in patients with pneumonia of unknown causes are reported in line with the conditions.
However, Cao Zhi, also admitted that the new, in line with the clinical condition of unexplained pneumonia cases reported is very common, the last reported cases are few and far between. Wen-Mei is a 27-year-old young women, even if have 20 weeks pregnant, in the clinical progress so quickly on the probability of severe pneumonia in very small, then should be a matter of enough importance to the Doctor.
From her disease, epidemiological history, as well as her daughter was diagnosed to analyze the situation, people can not be ruled out bird flu.
Children's Hospital of salvation
Has been for China's National Ministry of Health announced the first case of bird flu in people, Jun-Yao nightmare has come to an end three years.
In October 2005, Jun-Yao sustained high fever, cough, shortness of breath, low blood, due to "bronchopneumonia" was admitted to Children's Hospital of Hunan Province. At that time, Jun-Yao Xiangtan is the homeland of avian flu epidemic, he had the disease before the consumption of bird flu in dead poultry, the hospital is likely to consider him a person suffering from bird flu, and then treated in isolation until recovery.
Jun-Yao thanks to the success of the Hunan Provincial Children's Hospital where he set up the pediatric emergency transport system. This system for all children's diseases, and as long as the conditions change quickly, critically ill children across the province to pass through the operation of the transit system to the provincial children's hospital, including infectious diseases.
Say祝益民memory, Jun-Yao transit through the pre-hospital system from Xiangtan City transit through the Maternal and Child Health Hospital, which is key to the success of treatment. If this system did not, even children with their families requested transfer speed will not soon; if the system of children with a lack of professional support, children with their families requested transfer would not make a prompt decision.
祝益民still feel regret, Jun-yao, when the incidence of the Sisters of the clinical manifestations and is very similar to the avian flu has yet to have the opportunity to receive effective treatment, then at Shiga Yao a few days prior to the onset of death.
Two months later, Children's Hospital has treated the first two cases of bird flu in people Shuangtao Ouyang. Prior to this, small Ouyang in Guiyang local health room, hospital and the people in Guiyang County, Chenzhou City Second People's Hospital for treatment, has been around for two weeks, the last human bird flu was confirmed. Changsha, Chenzhou transfer from the small body has been weakened Ouyang, widely infiltrating the lungs, chest almost a "white lung" of the changes in body organs were seriously damaged. Parents turn to the road, does not have any hope.
Hospital did not give up the treatment, feel that the success of the Example No. 1, the first two cases must also be successful. Hospital 44 days after the rescue of the relay, in the capture of a storm after another, and finally put online a small Ouyang pulled from the dead back.
Before the onset of small Ouyang also lost a loved ones, his mother suffered from the symptoms of a disease the same as him, and finally died. Jun-Yao, whether the elder sister of the mother or small Ouyang, because hospital had not been reported to reception, so people were not included in the list of bird flu, the deaths of two people to open the mystery of bird flu has been added to both mystery .
祝益民said: "I think the key is early detection, early intervention, must be the overall co-ordination of the emergency system, emphasize not only medical, but also rely heavily on management. Human bird flu patients and the general requirements of critically ill patients do not like to save the need to set up a special the treatment group treated in isolation. medical personnel for treatment of human bird flu there is no clinical experience, to explore the need for a process can only take full advantage of patients, treatment programs at any time. "
Ouyang did not give a small hospital medicine Tamiflu use. Treatment at the time, experts believe that the virus of the body damage is a very complex pathophysiological process, not one can be completely cut off the drugs and side effects of Tamiflu for children can not be expected that the extent of its effects has yet to be proved.
祝益民explained that the role of all the virus to the human body, arguments are similar. Normal treatment of critically ill patients, clinical manifestations are in fact the whole body Sequential multiple organ damage, treatment of individual organs are to support and protect the most important consideration is to support the treatment of the pathogens are subjected to the protection of good organ damage, which is stabilize the patient's condition and where the key to success.
Experts told reporters that because of taking into account the patients infected with the pathogen, the cause of the inflammatory response in various organs, organ damage are the most important reasons, so the hospital from the latest anti-inflammatory treatment at the time the idea to use low-dose corticosteroids, in the course of treatment, when to replace high-dose treatment of SARS, the impact of short-course therapy. After summing up the two cases where children experience the application of this therapy be considered a very important success factors.
Embarrassing supporting disease control
CDC - Disease Control Department - Deputy Director in charge of the hospital - Bureau of Medical Affairs - Deputy Director in charge of the parallel system, the disease control and clinical artificially separated.
"Discovered late, severe, progress rapidly, the high mortality rate," Department of Health and Human avian flu has not changed over the years to describe the characteristics. National disease control in the current system, medical institutions are identified and controlled an important role in the spread of the epidemic, but the actual operation, it has been marginalized in the system has become awkward to deal with a supporting role in disease control.
Clinical prevention and control of irregular
"Whether or not be able to find early, mainly depends on the clinician's vigilance against infectious diseases." Beijing Chaoyang Hospital Respiratory and Critical Care Medicine Branch, deputy director of ICU and Cao Zhi, director of the new view, of bird flu although people still large sample of accumulated experience, but found that it is not difficult to level due to the limitations of medical institutions.
Cao Zhi, the new has taken part in more than 10 celebrity treatment in patients with avian flu. He told reporters that the incidence of avian influenza virus people after about five days, are in a critical condition, the time came to a standstill node. Prior to this, medical institutions and timely screening of cases, the application as soon as possible effects of drug Tamiflu, the key to the success of treatment.
The early people of avian flu, it is easy to be primary health care institutions as a common cold, pneumonia treatment. Has been confirmed in 38 cases of bird flu among people, the first consultation at the grassroots level in patients with medical institutions accounted for 61.8 percent of the total number, of which only a grassroots medical institutions for patients with suspicious and reported. (See Figure 1)
At present, people suspected bird flu patients to rely largely on screening "SARS" set up after the pneumonia of unknown causes at Direct Network system, which has been extended to the township hospitals. "Has been a period of time there is no SARS, and other clusters of respiratory infections occurred only in the current theory of inference, the straight pneumonia of unknown causes at the current system is primarily aimed at screening people prepare for bird flu." Cao Zhi, the new express.
"Clinicians want to pneumonia of unknown causes based on the criteria, do not need high-end medical equipment, medical institutions have as long as blood tests, chest X-ray film's ability to be able to." According to Cao Zhi, a new experience, often encountered in clinical practice will be consistent with the diagnosis of unexplained pneumonia patients, from screening to the minimal number of people in patients with avian flu, it is easy to make doctors into "all-or-none" dilemma, or are reported as suspected cases, or are given to rule out the possibility. Facts have proved that the doctor's vigilance in the prevention and control of avian influenza does play a role in trigger bodies, once a suspect, almost does not appear to be suspected in patients with misdiagnosis of the situation.
The grass-roots level the role of the first doctors in a number of unexplained disease group was found significantly more performance. Happened in 2008 in violation of the formula to add melamine caused kidney stones in infants are not part of infectious disease, nor did the network have been targeted at the system. It depends on the doctors found a number of major cases at the same time the same symptoms at the time of abnormal sensitivity to grass-roots awareness of medical staff demanding disease control.
"If we only rely on the awareness of primary care doctors for the disease control group of disease prevention and control, disease control at the grassroots level of a state of spontaneous, apparently is not enough. Is more important is to establish a set of standards, with guidance the rules. "relevant person in charge of Hunan Province, said CDC.
However, Huaxi Hospital, Sichuan University, Shi Yingkang introduction, at present, deal with mass flow of disease at medical institutions, particularly primary health care institutions are more chaotic. "For the prevention and control of infectious diseases of statutory law, step-by-step, but when faced with some not clearly defined how to deal with emergencies, medical institutions will be at a loss. Wenchuan earthquake such as at my house the first to discover the wounded gas gangrene both belong to potent infectious diseases, but also belong to the scope of nosocomial infection, we had no choice but to report both the disease control department, and the report of the medical affairs department. taking into account the reported gas gangrene of the greatest significance is the same brother treated the wounded seismic alert medical institutions , went to inform other medical institutions. This fuzzy rules on the same group is not conducive to the discovery and reporting of disease. "
Disease control in order to make up our country the existing grass-roots short board, March 10, from Beijing University School of Public Health to assume the "community of fever and diarrhea symptoms for early identification and early warning technology research," the official opening title. Against infectious diseases subject to the two most common symptoms - fever and diarrhea in the community health service centers, primary health care institutions to monitor the disease groups, the scientific feasibility of the design rules. At present, the subject has been incorporated into the National High-tech Research and Development Program (863 Program) thematic issues, is scheduled to finish in 2011 and the overall design flow.
President of the Peking University School of Public Health HU Yong-hua believes that "for all groups of unknown causes of disease prevention and control is still necessary to implement community-based prevention and control of medical institutions with a combination of the first consultation. The disease control which requires the community clinician should have basic skills, clinicians should have a basic awareness of prevention and control of infectious diseases. the knowledge of the structure of the two complement each other, common in the rule of law, regulations, guidelines, under the guidance of disease control constitute a grass-roots network, is the ideal status.
Separate the two sets of system
"Township hospitals experienced fever, General situation of poor patients, many patients would recommend the higher level hospitals.
"A person in charge of township hospitals told the reporter, even with blood tests and chest X-ray pictures of the equipment, they would not have to stay patient不愈by the administration in patients with pneumonia." Medical conditions are the main reason, followed have economic considerations, a series of rescue and other costs, we can not advance. "
Even if the medical institutions at or above the county level, of pneumonia of unknown causes hesitates is reported.溆浦县Liu Xiaopeng, vice president of People's Hospital told reporters, "If confirmed true human bird flu, of course, should be reported to hospital, but if the bird flu is not a person, will give the hospital administration or local health department brought many problems."
SHI Ying-kang said that in the normal, disease control and monitoring of education on the existence of the multi-management, CDC, public health administration department of disease control, as well as medical affairs department in the department to do a similar thing. If it is found and reported problem, it will involve all aspects. It is within the hospital medical information system has been excluded from the country's disease control network.
"Groups of unknown causes at the discovery and treatment of disease, the CDC and the hospital is the relationship between each other, subject to health administrative departments at the same time the unity of the deployment. At present, the country placed too much emphasis on disease control department of a leading role, will be the main energy and one of funding, to the neglect of health care institutions in the role of disease control, and then the cart before the horse. "祝益民president of the Hunan Provincial Children's Hospital believe that the CDC should be the strong support of medical institutions, health administration at the same
Department under the leadership of medical institutions to help achieve disease control mission. If the formation of hospital-led disease control system, can save a lot of intermediate links, to reduce the cost of communication department.
"Human bird flu on the run, found that in patients with clinical, clinical treatment, the more also depends on the clinical."祝益民think, clinical medical institutions and professional bodies for Disease Control CDC's role is equally important, not affiliation Today, it has been artificially marginalized.
"State funds allocated for disease control than the grass-roots level, monitoring is also less than the grass-roots level to implement, and the Doctor of clinical disease control at the grassroots level education is more the more weak, resulting in grassroots medical institutions engaged in disease control depends on work experience and ethics, the effect of natural discount . "Liu Xiaopeng also deep.
HU Yong-hua said that "after the SARS, China's disease control in the establishment of a new system, when not deliberately divided and clinical prevention. While trying to pinch the two together, but no good pinch."
Shi Yingkang also believes that the current CDC - Disease Control Department - Deputy Director in charge of the hospital - Bureau of Medical Affairs - Deputy Director in charge of the parallel system, the disease control and clinical artificially separated. Both in prevention and control of infectious diseases, or deal with unexpected events, and even construction of information network connection, there are a lot of questions. "Not as good as the division of disease control from the administration to go on to manage the medical affairs department, the following specific and up to now has been the implementation of sophisticated health care system, while improving the relevant laws,
Regulations and technical specifications. The only way to achieve cost-effective disease prevention and control. "
"Health care organizations can be hard to do disease control, but also depends on the country on whether the hospital in place of compensation." At HU Yong-hua, the last century 90's will market medical institutions and medical institutions to make disease control requirements, is itself a perverse theory, "even though the hospital does not want to declare, but do not consider professional ethics, simply from the operator's perspective, prevention is certainly moving in the opposite direction can not be combined."
Legal difficulties
Hunan Provincial Department of Health Emergency Response Office of the Pang and then think, "man's awareness of the disease are known from the unknown to the process, in the process, must pay a price. We have to do is to shorten this from the unknown to the known process, to put a minimum price, which required the support of scientific research. "
Ministry of Health has issued a "people bird flu clinic program" (hereinafter referred to as "treatment program") for the guidance of medical institutions, the current version has been updated to 2008. "The Ministry of Health clinic program of organization are the experts, according to information provided by the World Health Organization, to draw people around the world where the experience of patients with avian flu prepared." Cao Zhi, a new introduction for the people of our country there bird flu, the Ministry of Health received at the first patient case report, will be reported directly through the network system to obtain relevant information on the patient for analysis, confirmed at the same time, it will be effective and informative programs to the clinic. However, after the diagnosis of patients with clinical experience, have not updated in time.
A lot of courage to participate in the grass-roots level where the bird flu medical staff believe that the only treatment program of guidance, refer to the actual operation of little significance.
"For the academic aspects of the disease groups, a summary of my country to do very well, lost a lot of valuable experience." HU Yong-hua of the view that the clinical experience of an unknown infectious disease summary, the system required the joint efforts of experts, including experts in epidemiology, basic medical experts, clinical experts, or even in statistics, sociology experts also involved. During SARS, our country is very rich information on the case, but because no one organization to conduct in-depth research, no development on a lot of information lost in vain.
Due to institutional constraints, the relevant laws and regulations and technical specifications of the perfect HU Yong-hua has become the most important solution to the problem. In his view, the emphasis in our country has been one case, three systems (plans and mechanisms, institutions, the rule of law), the rule of law are fundamental. "SARS raid so that we have learned a useful skill - plans to do. Even though a lot of plans in real time applications, was found to be not practical, but at least we have a good start. China's disease prevention and control, but also stop relying on the existing system, the phase of the implementation of the rule of man.
The rule of man to the rule of law from a very necessary process, but improve the relevant laws, regulations and technical specifications, has always been the direction of our efforts should be made. "
According to him, in 2008, "General Hospital infectious disease management to evaluate the content of norms and standards" of the research work at Peking University School of Public Health started, the purpose is to clarify the General groups of medical institutions in case of disease and injury in the duty , as well as the realization of the path of duty. Other specialty hospitals, health care, the prevention and treatment by institutions such as the formulation of the relevant norms are also planned. Disease control system of the existence of separate systems, may be another way to gradually bridge.
