Sie sind auf Seite 1von 12

SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

ICD-10 U04.9

1. 
:

      (Severe Acute
Respiratory Syndrome : SARS)  ! !" (Guandong)
" "#    $%
 .%. 2545 (#&'  #!*+ 
' #* ,- ") , #-,* '/ 0-13*!
  "
6 '
  
,* !*" 7 !- 29
*'%  - , *'   *8
" 
 6  !6;  ,!
!
 *'%" 7 !-- %0<6  "  ' -=', !

,!"! - '  ;
#0    / ," ! 
*   
'! 13"
6 ,!6
 '-,## 0 3 38-40 *! %<' ! 
*! -   -   0- '! ! "- ! ,
 # '  ! +! *!   ! (*+ 6! ' 
,!  3 0 3 !  10 
- *! ) "*! " *'-& '
10

  
  *' ! !
D PCR, ELISA, IFA '
 6 ,! '      1!!
D PCR "6"!  
2 6
#0  ,* (6 nasopharyngeal aspirate ') "! 6

  !  +   2 ! #0  ,* 6!* !  2 !
D   ! !
D
PCR 2     
- !-,!'!-K' "! ! !
D ELISA 
IFA  "
  - 3 (paired sera) 
- 3#0  '-!-K'"

159

 -    ,! (SARS coronavirus : SARS-CoV) *+ 6  -


*'6,--M3-
- " -  6,!K ' 
 6"!  6
 +,  !-!
D PCR
K
-#   - 6# -3

'
#-3' !
 *' '   ! !

  *8
"

 13* ! 
- " " 1 $%
 2545 '13* ! *+ 13* ! 
(suspect case)  -,#3 (38. #0  ,*) ,   K '-*'!"

-1  0    ' '! 10 !   *! ,  1)
-16
13* ! ( 313* !  3 ! - -1 " K-3 K
- '     7  13* ! ) 2) -*'!"

,*   
 
 -' 3) %      
 -'      - !-=0
13  6!"

 ,- " - * '!"#
 " !
13* ! '*+ (probable case)  13* !  1 M 
* -* !-  RDS (Respiratory distress syndrome) -1! !
D
 6    1 !
D# 0 ,*
'' '!*! "" '#0  * M3-
- 
(immunological factors) 0 ,-*+  #6  ! #-313* !
'*+ ! -  # '"-- !   - !
"  6  6!   ! +! 13* ! *'-& ' 89  *+ *"

("*! "  ' 11) #-3 !!-6!' ! !-  


# 6!
"#0  3<&'#13*! ,    '*'K"!
#-3-  K  !"*! " 
- #0   -   3 #0      '
1, 6, 15 ' -! ' 50  -   24 *,* -   25-44 *
-   45-64 * '-   65 *# 0 ,* "-K 

160

2.  
:
6,!"  "  6 ,! (SARS coronavirus)
0-<&'"! ! % 
+"  - 6 ,!
   "! *+ RNA single stranded virus -  - !% Coronaviridae
6-!- -!,!!,*  -6!
",      1-2 !
 ''*!'#13*! & M3-
 '  =0 4 !  '
13* ! -  ! "-T 6 ! ,*K 6 ,  '!- 
56. K 6 K ! 10,000 "!" 15 

3.  
:
" 
-#
#0   6!  $%
 * .%. 2545
  ! !" #    , ' ,*  29 *'%  !*6
-
 " * 'U
 !- - *'%"'! '
*
U
-' M  *'% (local transmission)  9 *'%  
'  ;
#0  *'% (!-#"*
%</'," ! )
   
* '! - 0  - , *'%K ' K
 
 *'  *8
" 

'*'%-6
 ""
""
""
 - "- !  5 W- 2546  - , 
*'%!, =3!-! (-13*!  - 8,098   6!
" 774
 ) ' ' K Y'! "     -="!' 
 -, ! +! 0 13* !     ! 7 "
6  *8
" 
 
* ," !
'   (-< 2547) -1"3
6 1  6 ,* !
',* 6-6 *+ -+ 7 0=3!-,  ! +!

161

4.  
:
,- 6 "6 "!*  6
#  3 "
 !"  '6'-

5.    
:
 3  -1 " (direct contact)  K-3
K '  #13* ! Y ' K-3 K ,(droplets) 1 
 # 6 (fomites) 'K '
#13* ! ,  ! ,--#  -36   7 !- % (airborne)

6. 
:
-' 3 6! 3-10 !

7. 
:
,-*+  # 6  !,--  -*! '
,    21 ! , -  6!-  '  '* 
K  *+ - 3""
6 !- K6
,*36-6 !

8.
!
"#" $  :
,- " ! 66"
%-!-,!"  '
    -  + K ,--=!
' !-""
' !- , 

162

9.  
$
%

. 
 
 ' K*'66        K     " ! *   -*+  
- <# - !   '- 6+ - ! 
/ 7

.        


  
1.   : =    MZ'6  
  13* !  (suspect case) '13* ! '*+ (probable case) 
13*! * !--*'!"

- ' ,*K  D&#
 ! K  - -   0'"   ,* K 
' !
  -!-
2.    :
-  13*!  "   !-  *+ "-"Z ,--"  ,-6 *% '-'= %  
- 6-"!-"
6 #-! (universal
precautions) ' *  "+- 'Y0- !-'=
6 *& !- - =3" 6 * ,   - (Face
mask 6
N/R/P 95/99/100  ) ! " =- 6 !   K
'3\ ( "
6
6!
 )
- ,-  13*! ,* ! K*&#- 'K
K !     K*+
-   '- '!6*&6'
 
#13* ! !- 6 - --

163

-   13  *  ! ,      3    < -    # 0  ,- -  , #   !


   72 6! - ,-, ',--    '1"! 
*8
"
-*"
6 CBC M! #0 !-
-"!#

   -*+ *"
^^ '
&K  13*! 
 ,  '!  13* ! -"
"-  1 *   ' !    *8
"

"- # ' KK 13* !    


-   10 ! '  ,*36-6 (6
 K = %0< = *'K ^^) *+ !   10 ! 
* ' #
-     ' 6     '   
-16
  7 *+ !   10 !
- 13* ! '   !!!-1*
*-3 '
- 7
- 6' <
6636+ K-3 K !
 = "
- *

*= K  1 
 ' <
663 6! =  K 1-1U
!- *
*= 

- 13* ! -,#- - (& M3-
  38 
! ,#   2  ) -1
*"
'   6 ,-#0  
  ^^ !-   
3.    : !6! *& 6
6
   !
 (disposable) "
  =# '"
6   *
' K,*K
"-!
D *&"   K,*6 -" T6  #-! '6 K T6 - 
$D
K ,!6+  '6 13*!  -K-
4. 

 : 13 
-   
' !, 
K ' K'*8
" "
!   "   (home quarantine)  
-  #-313-1 (' # !
D
"
"# ^^)
164

-   *+ ! 10 ! '"*! 


-  
! ,# ! ' # -3  D&# %-=-
- 13 - 1
- -,#   7 #   !  - ',*  
5.  !"#"
$
"
$ : ,--!   *
6. $$$
"
$%  : ! '*= '
13* ! !*+ probable  suspect case ,-*+ 13* ! (exclude)  , 
#-3,-     3 -"! " (under-investigation) 
 ' #"!* "  *    !#*! !- *'!"


,* -*'%-'
7. 
& : -6 " ,! 
,!
(Ribavirin) !3
 "   !, 1 ,  " "' '
- *! ("%0<
!
  
- "
-) '" 3  13 6  !6;' !- <
  6

.   
1.  "   &'-'%3  * 8
  "
 
 
    '!D&#  -!-*+ ! *' 
'" &'K 6 " 7 6 Y'!'!  !-  "!
13
*'%   !-"
6    ' 
!-   ^^
2.  !-3'#%0<*'66 !,*1 #  
!-# '*8
" "
, =3 "
3.   - ! (hot line) "K=-' #-3
*'66
4. 
-!-#-#+#'Y'!'! '
!
   *'  
"!13 " " 3  

  #M#13  "! 13 -,# ( ! Infrared
165

thermoscanner)  13* !    


-=0*'% '
""    "!"  -#&'K  *'%
, !-,*=0"!  
*'%, !
5. " -!--    ' 13* !  
"   !-3     <  '
* " 
6. " --  *8
"
  -!
 %" 
*' %3 *8
"
# -  6 %3 !-'
*  6"
(CDC)  Z-
  !

 13* !

.  ! " # $%  :


6   !"
"" 
-  7 
' -
!"  "' 
 " 0 ''"%<Z
'-  

$.  &
"' :
1.   13* !  " -W - ' !*'% .%. 2548  
( *+ M!'
D&#'   6"
Public health emergency
of international concern : PHEIC) 13* ! "  ,* 
 -  
2. 6-"
' !*'%"-W - ' !
*'% .%. 2548  K '!-'     '  
 -     #-3' K
 M!'!
$" !- K"
*'%" 7

10. &'" (


)"*  #+!# :
-1*3 !     - - 2546 -!  - 13* !
- * '!"

-   ' 313  13* ! !- 40 
*+ 13* ! '*+ (Probable case) 9  ( 6!"
2  ) *+ 6!"6"

3  ( 6!
" 2  ) '6!, 6  ,- 6!
" '13*! 
166

(Suspect case) 31  ,- 6!"


*+ 6!"6"
7  '6!, 24 
,-- 6 13* ! 
#0   *'%, *'%, 0,-=3  *+   
-  ' #  ,+  , 
1'"D
  !'
D
  !   0 D  *'%, , =#-3 (& 31 $<M- 2546)
!   !  * 2545  ' 10.2 
*+ 19,571  
( !-, 6 ' =0 40,641  )

11. $#
)"*  #+!# :
*'%, -1*3 ! "*'% (imported case)   
13* !   (      13 6  !6; - ) "
6
#&'! ' 313*! *  1
*"
/  
--,#
 
- 
-*'%, ',  *'!"
-1 
= K%  3
- 6-"* "
6 (0 " -,! ""
"
"" 
-    !)  #-!   *+ ! K;6 !  ,-- 
6 13* ! 
#0   *'%, 13* !    !  ; (14  30
 ) -*'!"

- 1
 ;

12.  ,$&-/*#&& *,"


# "
); <$" %" 
13 +"! ",  Y0'!-*&*   =3"
+"!  "!! ,* ,  -+  #! +  + ,- creatinine phosphokinase, urea, electrolytes K #" C-reactive protein) ! +"!  "! '- 2 !
D  

1. (  
!  )  "* PCR

'#%$ ()   "!  SARS-Coronavirus RNA,
Influenza virus RNA ' 6 "!  "
 6 Legionella spp.

167

*
  %"+
- Throat swab, nasopharyngeal swab + viral transport
media *
-& 2-3 -.  nasopharyngeal aspirate ("!  SARSCoronavirus RNA, Influenza virus RNA)
- ' +  -   gastroenteritis +*'-&
10-50 -. ("!  SARS-Coronavirus RNA)
- EDTA-blood *
-& 3-5 -. ( 6 Legionella)
- *!' *'-& 5-10 -. ("!  "
 6 Legionella)
)%,-/
  !+"!  ' '13*! 
--
#
- Nasopharyngeal swab - 6! *  6
Dacron
polyester-tipped , -- calcium alginate   ! * #,* -3
 6 7  "'1   - ! 5 !
 !0 7  swab
- -  transport media " * ! 
  *
 +"! 
 
 (+"!    2  ""! )
- Throat swab 6,-  K-  transport media ! 
* ,-
 *
 +"!  
 (+"!    2  "
"! )
- 
$$% - + mid stream *'-& 5-10 -. #! ,6
- *  EDTA - '  K*'-& 5 -. +
 -    #+   -  EDTA
- #% +  -   gastroenteritis +*'-&
10-50 -.
*
  -8""%$"
- "!   - ,-6 +  4 ,-'"
 K #+
- "!    "  6K K  transport media
, 0--
168

- "! -  * * #6  


,- $ 
  *
  M6 '"!   
  !
U
-  "! ="
 2 6   !- '*j
"
 #+0  ! ' < K    *
Y   !
'"
- K#+ &" !   swab  K  +,! -70 "
  '"
  K #+  (dry ice) "! 6
 +'"*

6 13* ! 6
#"!  !  + - +"! !  K=
!
  !
 %"D&# +!  (' throat swab   M  48 6-.)

2. (  
! $&   # ) SARSCorona virus

'#%$ ()  "! '  "
 "6
SARS-Corona virus 6 ,!
U3  ,!
U3  ,! ,!'
 ,-- (Mycoplasma) '-   (Chlamydia)
*%"+$  $  - 3-5 -.  *'-& 5-10
-.
)%,-/
 
- '   K*'-& 3-5 -.   *%
6 *
Y 
 " 
 ,! &
 M3-
   #+"! +#"3 + 4 
 K
  ' 2   - 
- -   2 
 *'-& 21 ! -!
*
  -8""%$"
-  +  " !    *
,-      -  "  !K 
"! , 0--
- "! -* * 6   
 
- --"#-+   -

169

,- $ 
  *
  M6 '"!   
  !
U
-  "! ="
 2 6    !-  '*j
"
 #+0  ! ' < K    *
Y   !
'"
- K#+ "! 6
+'"*
613*! 6

#"!  ! + -+"! !  K= !
 !
 %"
D&#  "!   1 -
" #
1. !
D +"! "!!
' 6 SARS *+   !
+"! "!!
' 6 ,# !   "! -!
 %" 
Y ,!'
 
2. &, --=" - transport media ,  "
"#! 
,  Y ,!'
  = !
 !
 %"D&# !
 %"  %3 !
 %"   " ! (" '"
- K#+- transport media)

170

Das könnte Ihnen auch gefallen