治疗流程
请注意药品名称和品牌、药品处方或地区之间的配方/用药途径和剂量可能有所不同。治疗建议针对患者特定群体提出： 查看免责声明
所有患者
根据世界卫生组织 (WHO) 或美国疾病预防控制中心 (CDC) 的病例定义，对于被确定存在感染风险的患者，应立即将她们转移至配备私人卫生间设施的房间进行隔离。[90]Centers for Disease Control and Prevention. Case definition for Ebola virus disease (EVD). November 2014 [internet publication]. https://www.cdc.gov/vhf/ebola/hcp/case-definition.html [93]World Health Organization. Case definition recommendations for Ebola or Marburg virus diseases. July 2019 [internet publication]. https://www.who.int/csr/resources/publications/ebola/ebola-case-definition-contact-en.pdf?ua=1
照料患者的所有医务工作者都必须遵照公布的治疗方案穿戴个人防护设备 (PPE)。
所有受污染的物品（例如服装、床上用品）都应视为具有潜在传染性。
应根据当地和国家治疗方案采集和运送标本，以进行实验室检查（例如埃博拉病毒逆转录聚合酶链反应、全血细胞计数、血清肌酐和尿素、肝功能检查、动脉血气、凝血功能检查、血培养和针对其他疾病 [例如疟疾] 的检查）。慎重选择检查项目对降低实验室工作人员和其他医务工作者面临的传播风险至关重要。
在患者住院早期给予中心静脉导管置管（如果可能）有助于采集血液和输液，同时最大限度地降低针刺伤风险。[137]Rees PS, Lamb LE, Nicholson-Roberts TC, et al. Safety and feasibility of a strategy of early central venous catheter insertion in a deployed UK military Ebola virus disease treatment unit. Intensive Care Med. 22015 May;41(5):735-43. http://www.ncbi.nlm.nih.gov/pubmed/25761540?tool=bestpractice.com
推荐人员配备比为至少每一个临床工作者（指护士、临床主任、或内科医生）分配四名患者，以使患者能够接受每天三次的病情评估。[139]Lamontagne F, Fowler RA, Adhikari NK, et al. Evidence-based guidelines for supportive care of patients with Ebola virus disease. Lancet. 2018 Feb 17;391(10121):700-8. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31795-6/fulltext http://www.ncbi.nlm.nih.gov/pubmed/29054555?tool=bestpractice.com
医务工作者应协助患者与家人和朋友的联络（例如，利用移动电话或网络），以期在不增加感染风险的前提下降低患者的心理困扰。[139]Lamontagne F, Fowler RA, Adhikari NK, et al. Evidence-based guidelines for supportive care of patients with Ebola virus disease. Lancet. 2018 Feb 17;391(10121):700-8. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31795-6/fulltext http://www.ncbi.nlm.nih.gov/pubmed/29054555?tool=bestpractice.com
埃博拉病毒感染是一种法定报告传染病。
针对特定患者群中所有患者的治疗建议
对于可耐受口服给药且脱水不严重的患者，可以使用口服补液溶液，但大多数患者需要静脉补液，可使用生理盐水或乳酸林格氏液。[20]Bah EI, Lamah MC, Fletcher T, et al. Clinical presentation of patients with Ebola virus disease in Conakry, Guinea. N Engl J Med. 2015 Jan 1;372(1):40-7. https://www.nejm.org/doi/full/10.1056/NEJMoa1411249#t=article http://www.ncbi.nlm.nih.gov/pubmed/25372658?tool=bestpractice.com [92]Hunt L, Gupta-Wright A, Simms V, et al. Clinical presentation, biochemical, and haematological parameters and their association with outcome in patients with Ebola virus disease: an observational cohort study. Lancet Infect Dis. 2015 Nov;15(11):1292-9. http://www.ncbi.nlm.nih.gov/pubmed/26271406?tool=bestpractice.com 可选择的路径有周围或中心静脉输注、或骨髓腔内输注。[139]Lamontagne F, Fowler RA, Adhikari NK, et al. Evidence-based guidelines for supportive care of patients with Ebola virus disease. Lancet. 2018 Feb 17;391(10121):700-8. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31795-6/fulltext http://www.ncbi.nlm.nih.gov/pubmed/29054555?tool=bestpractice.com
应根据临床检查情况（例如脱水程度和休克体征）和液体损失量（例如腹泻和/或呕吐量）评估所需的静脉输液量。具有腹泻症状的发热患者可能需要大量补液（高达 10 L/天）。[45]Kreuels B, Wichmann D, Emmerich P, et al. A case of severe Ebola virus infection complicated by gram-negative septicemia. N Engl J Med. 2014 Dec 18;371(25):2394-401. https://www.nejm.org/doi/full/10.1056/NEJMoa1411677#t=article http://www.ncbi.nlm.nih.gov/pubmed/25337633?tool=bestpractice.com
必须严密监督和频繁监测患者情况，因这对于评价患者对治疗的反应和预防容量超负荷非常重要。应频繁检查患者是否有休克、脱水或水中毒的体征，并相应地对输液速度做出调整。必须每天对生命体征（如心率、血压、尿量、胃肠道液体的丧失）和容量状态进行至少三次的系统性监测，以发现低血容量。[139]Lamontagne F, Fowler RA, Adhikari NK, et al. Evidence-based guidelines for supportive care of patients with Ebola virus disease. Lancet. 2018 Feb 17;391(10121):700-8. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31795-6/fulltext http://www.ncbi.nlm.nih.gov/pubmed/29054555?tool=bestpractice.com
隔离设施内现场备有床旁诊断化验，有助于更有效地监测患者的生化状态，并减少与标本运送相关的风险。[112]Fowler RA, Fletcher T, Fischer WA 2nd, et al. Caring for critically ill patients with Ebola virus disease. Perspectives from West Africa. Am J Respir Crit Care Med. 2014 Oct 1;190(7):733-7. https://www.atsjournals.org/doi/full/10.1164/rccm.201408-1514CP#.VEe1OvldWnA http://www.ncbi.nlm.nih.gov/pubmed/25166884?tool=bestpractice.com 应每天进行电解质监测，必要时充分给予。[20]Bah EI, Lamah MC, Fletcher T, et al. Clinical presentation of patients with Ebola virus disease in Conakry, Guinea. N Engl J Med. 2015 Jan 1;372(1):40-7. https://www.nejm.org/doi/full/10.1056/NEJMoa1411249#t=article http://www.ncbi.nlm.nih.gov/pubmed/25372658?tool=bestpractice.com 如果正在进行大量静脉输液，或者出现严重的生化异常，可以考虑进行更频繁的监测。
可能需要大量补充钾（例如每小时 5-10 mmol/L [5-10 mEq/L] 氯化钾）。[22]Schieffelin JS, Shaffer JG, Goba A, et al; KGH Lassa Fever Program; Viral Hemorrhagic Fever Consortium; WHO Clinical Response Team. Clinical illness and outcomes in patients with Ebola in Sierra Leone. N Engl J Med. 2014 Nov 27;371(22):2092-100. https://www.nejm.org/doi/full/10.1056/NEJMoa1411680#t=article http://www.ncbi.nlm.nih.gov/pubmed/25353969?tool=bestpractice.com [129]Wolf T, Kann G, Becker S, et al. Severe Ebola virus disease with vascular leakage and multiorgan failure: treatment of a patient in intensive care. Lancet. 2015 Apr 11;385(9976):1428-35. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2962384-9/fulltext http://www.ncbi.nlm.nih.gov/pubmed/25534190?tool=bestpractice.com [142]Clay KA, Johnston AM, Moore A, et al. Targeted electrolyte replacement in patients with Ebola virus disease. Clin Infect Dis. 2015 Sep 15;61(6):1030-1. http://www.ncbi.nlm.nih.gov/pubmed/26056238?tool=bestpractice.com
血乳酸水平高是低灌注的可靠指标，有助于指导进行液体复苏。[112]Fowler RA, Fletcher T, Fischer WA 2nd, et al. Caring for critically ill patients with Ebola virus disease. Perspectives from West Africa. Am J Respir Crit Care Med. 2014 Oct 1;190(7):733-7. https://www.atsjournals.org/doi/full/10.1164/rccm.201408-1514CP#.VEe1OvldWnA http://www.ncbi.nlm.nih.gov/pubmed/25166884?tool=bestpractice.com
应参阅世界卫生组织的相关指南，以了解有关液体和电解质管理，以及急性期和康复期维持营养充足的具体建议。
WHO: optimized supportive care for Ebola virus disease Opens in new window
针对特定患者群中所有患者的治疗建议
应使用一线治疗药物：对乙酰氨基酚进行治疗（适用于疼痛和发热）。[138]World Health Organization. Optimized supportive care for Ebola virus disease. July 2019 [internet publication]. https://www.who.int/publications-detail/optimized-supportive-care-for-ebola-virus-disease [146]World Health Organization. Clinical management of patients with viral haemorrhagic fever: a pocket guide for the front-line health worker. February 2016 [internet publication]. https://apps.who.int/iris/bitstream/10665/205570/1/9789241549608_eng.pdf?ua=1
更严重疼痛的治疗，首选阿片类镇痛剂（例如曲马多、吗啡）。[138]World Health Organization. Optimized supportive care for Ebola virus disease. July 2019 [internet publication]. https://www.who.int/publications-detail/optimized-supportive-care-for-ebola-virus-disease [146]World Health Organization. Clinical management of patients with viral haemorrhagic fever: a pocket guide for the front-line health worker. February 2016 [internet publication]. https://apps.who.int/iris/bitstream/10665/205570/1/9789241549608_eng.pdf?ua=1
由于相关的出血风险增加和潜在的肾毒性，应避免使用非甾体抗炎药（包括阿司匹林）。[138]World Health Organization. Optimized supportive care for Ebola virus disease. July 2019 [internet publication]. https://www.who.int/publications-detail/optimized-supportive-care-for-ebola-virus-disease [146]World Health Organization. Clinical management of patients with viral haemorrhagic fever: a pocket guide for the front-line health worker. February 2016 [internet publication]. https://apps.who.int/iris/bitstream/10665/205570/1/9789241549608_eng.pdf?ua=1
止痛药可能有助于缓解吞咽困难（如果存在）。
第一选择
对乙酰氨基酚: 儿童：10-15 mg/kg，口服/直肠给药，需要时每 4-6 小时一次，最大剂量为 75 mg/kg/天；成人：500-1000 mg，口服/直肠给药，需要时每 4-6 小时一次，最大剂量为 4000 mg/天
第二选择
曲马多: 儿童：咨询专科医生，获取剂量指导；成人：50-100 mg，口服（速释型），根据需要每 4-6 小时一次，最高剂量 400 mg/d
或
硫酸吗啡: 儿童：0.2-0.4 mg/kg，口服，需要时每 4-6 小时一次，或者 0.05-0.1 mg/kg，静脉使用，需要时每 4-6 小时一次；成人：2.5-10 mg，口服/静脉使用，需要时每 4 小时一次
针对特定患者群中所有患者的治疗建议
建议使用口服或静脉用止吐剂（例如昂丹司琼、异丙嗪）。[138]World Health Organization. Optimized supportive care for Ebola virus disease. July 2019 [internet publication]. https://www.who.int/publications-detail/optimized-supportive-care-for-ebola-virus-disease [146]World Health Organization. Clinical management of patients with viral haemorrhagic fever: a pocket guide for the front-line health worker. February 2016 [internet publication]. https://apps.who.int/iris/bitstream/10665/205570/1/9789241549608_eng.pdf?ua=1
第一选择
昂丹司琼: 儿童：咨询专科医生，获取剂量指导；成人：8 mg，口服，每 12 小时一次，或者 4 mg，静脉给药，需要时每 8 小时一次。
或
异丙嗪: 儿童：咨询专科医生，获取剂量指导；成人：12.5-25 mg，口服，需要时每 4-6 小时一次
针对特定患者群中部分患者治疗的附加建议
WHO 强烈建议将 atoltivimab/maftivimab/odesivimab（也称为 REGN-EB3）或 ansuvimab（也称为 mAb114）用于确诊扎伊尔埃博拉病毒感染的患者，以及确诊扎伊尔埃博拉病毒感染的母亲所生的未确诊感染的 ≤7 日龄新生儿。[156]World Health Organization. Therapeutics for Ebola virus disease - Democratic Republic of the Congo. Aug 2022 [internet publication]. https://www.who.int/publications/i/item/9789240055742 对其他种类埃博拉病毒的疗效尚未确定。
美国食品药品监督管理局（Food and Drug Administration, FDA）批准 atoltivimab/maftivimab/odesivimab 和 ansuvimab 用于治疗儿童和成人的扎伊尔埃博拉病毒感染，并且 atoltivimab/maftivimab/odesivimab 已获得欧洲药品管理局的孤儿药资格认定。
与标准治疗相比，atoltivimab/maftivimab/odesivimab 和 ansuvimab 可能降低死亡率（中度确定性证据）。然而，它们可能对病毒清除所需时间影响很小或没有影响。尚不确定它们是否会增加严重不良事件的风险。[156]World Health Organization. Therapeutics for Ebola virus disease - Democratic Republic of the Congo. Aug 2022 [internet publication]. https://www.who.int/publications/i/item/9789240055742 PALM 试验发现，在接受 atoltivimab/maftivimab/odesivimab 治疗的患者中，28 天死亡率为 33.5%，对照组（ZMapp）则为 51%。接受 ansuvimab 治疗的患者中，28 天死亡率为 35.1%，对照组则为 49.7%。[157]Mulangu S, Dodd LE, Davey RT Jr, et al. A randomized, controlled trial of Ebola virus disease therapeutics. N Engl J Med. 2019 Dec 12;381(24):2293-303. https://www.doi.org/10.1056/NEJMoa1910993 http://www.ncbi.nlm.nih.gov/pubmed/31774950?tool=bestpractice.com
不良反应包括超敏反应和输注相关反应、发热/寒战、心动过速、呼吸急促、低血压和肝酶升高。
两种治疗均为单次静脉输注给药，应在确诊后尽快给药。它们可用于老年人、孕妇和哺乳期女性以及儿童和新生儿。
在世界许多地区，获得这些治疗药物具有挑战，选择取决于可得性。在疾病暴发期间，可能需要在同情用药框架下使用。
第一选择
atoltivimab/maftivimab/odesivimab: 儿童和成人：每种成分 50 mg/kg，单次静脉输注
或
ansuvimab: 儿童和成人：50 mg/kg，单次静脉输注
针对特定患者群中部分患者治疗的附加建议
在一些情况下，尤其是在难以进行诊断检查的流行区，患者的治疗方案通常包括给予广谱抗生素。如果开始使用，则在 48 小时后再次评估。[138]World Health Organization. Optimized supportive care for Ebola virus disease. July 2019 [internet publication]. https://www.who.int/publications-detail/optimized-supportive-care-for-ebola-virus-disease
针对特定患者群中部分患者治疗的附加建议
来自以往埃博拉病毒感染疫情暴发期间的有限证据表明，在急性感染期，输注康复患者的血液可能使患者受益，并可能降低病死率。[6]Roddy P, Howard N, Van Kerkhove MD, et al. Clinical manifestations and case management of Ebola haemorrhagic fever caused by a newly identified virus strain, Bundibugyo, Uganda, 2007-2008. PLoS One. 2012 Dec 28;7(12):e52986. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0052986 http://www.ncbi.nlm.nih.gov/pubmed/23285243?tool=bestpractice.com [151]World Health Organization. Interim guidance: potential Ebola therapies and vaccines. November 2014 [internet publication]. https://apps.who.int/iris/bitstream/10665/137590/1/WHO_EVD_HIS_EMP_14.1_eng.pdf?ua=1 与使用全血相比，使用康复期患者血浆很可能更切实可行且更有效。[152]Kreil TR. Treatment of Ebola virus infection with antibodies from reconvalescent donors. Emerg Infect Dis. 2015 Mar;21(3):521-3. https://wwwnc.cdc.gov/eid/article/21/3/14-1838_article http://www.ncbi.nlm.nih.gov/pubmed/25695274?tool=bestpractice.com [153]Gutfraind A, Myers LA. Evaluating large-scale blood transfusion therapy for the current Ebola epidemic in Liberia. J Infect Dis. 22015 Apr 15;211(8):1262-7. https://jid.oxfordjournals.org/content/211/8/1262 http://www.ncbi.nlm.nih.gov/pubmed/25635118?tool=bestpractice.com
在几内亚进行的临床试验中，未能证实接受康复者血浆治疗的患者可以获得生存获益，尽管该治疗似乎是安全的，且无严重并发症的记录。[154]van Griensven J, Edwards T, de Lamballerie X, et al. Evaluation of convalescent plasma for Ebola virus disease in Guinea. N Engl J Med. 2016 Jan 7;374(1):33-42. https://www.nejm.org/doi/full/10.1056/NEJMoa1511812#t=article http://www.ncbi.nlm.nih.gov/pubmed/26735992?tool=bestpractice.com [155]van Griensven J, De Weiggheleire A, Delamou A, et al. The use of Ebola convalescent plasma to treat Ebola virus disease in resource-constrained settings: a perspective from the field. Clin Infect Dis. 2016 Jan 1;62(1):69-74. https://academic.oup.com/cid/article/62/1/69/2462604/The-Use-of-Ebola-Convalescent-Plasma-to-Treat http://www.ncbi.nlm.nih.gov/pubmed/26261205?tool=bestpractice.com
世界卫生组织已经发布了有关使用康复期患者血液/血浆的指南。
针对特定患者群中所有患者的治疗建议
患者可能受益于服用适宜的抗酸剂或质子泵抑制剂（例如奥美拉唑）。[138]World Health Organization. Optimized supportive care for Ebola virus disease. July 2019 [internet publication]. https://www.who.int/publications-detail/optimized-supportive-care-for-ebola-virus-disease [146]World Health Organization. Clinical management of patients with viral haemorrhagic fever: a pocket guide for the front-line health worker. February 2016 [internet publication]. https://apps.who.int/iris/bitstream/10665/205570/1/9789241549608_eng.pdf?ua=1 止痛药可能有助于缓解吞咽困难。
第一选择
奥美拉唑: ≥10 岁的儿童和成人：20 mg/天，口服，每日一次
针对特定患者群中所有患者的治疗建议
推荐对腹泻患儿补充锌剂。[146]World Health Organization. Clinical management of patients with viral haemorrhagic fever: a pocket guide for the front-line health worker. February 2016 [internet publication]. https://apps.who.int/iris/bitstream/10665/205570/1/9789241549608_eng.pdf?ua=1
应当评估患者是否存在胃肠道感染，并予以相应治疗。[146]World Health Organization. Clinical management of patients with viral haemorrhagic fever: a pocket guide for the front-line health worker. February 2016 [internet publication]. https://apps.who.int/iris/bitstream/10665/205570/1/9789241549608_eng.pdf?ua=1
2014 年西非疫情暴发时，粪便管理系统在严重腹泻患者中的应用非常成功。其耐受性良好，且可预防医务工作者的感染以及有益于感染控制。[114]Dickson SJ, Clay KA, Adam M, et al. Enhanced case management can be delivered for patients with EVD in Africa: experience from a UK military Ebola treatment centre in Sierra Leone. J Infect. 2018 Apr;76(4):383-92. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903873 http://www.ncbi.nlm.nih.gov/pubmed/29248587?tool=bestpractice.com
应对腹泻进行保守治疗；一般不推荐使用肠蠕动抑制剂。[138]World Health Organization. Optimized supportive care for Ebola virus disease. July 2019 [internet publication]. https://www.who.int/publications-detail/optimized-supportive-care-for-ebola-virus-disease
第一选择
锌: 患儿年龄<6 岁：10 mg，口服，每日一次，持续 10-14 天；患儿年龄≥6 岁：20 mg，口服，每日一次，持续 10-14 天。
针对特定患者群中所有患者的治疗建议
虽然不常见，但是癫痫发作是晚期疾病的一种临床表现，且对医疗保健工作人员构成危险，原因在于它们会增加医疗保健工作人员接触患者体液的风险。
识别和纠正影响因素（例如高体温、低灌注、电解质紊乱、低血糖）至关重要。
苯二氮卓类药物（例如静脉使用/肌内注射或经直肠给予地西泮）可用来中止癫痫发作，抗惊厥药（例如苯巴比妥）可以治疗反复的癫痫发作。[138]World Health Organization. Optimized supportive care for Ebola virus disease. July 2019 [internet publication]. https://www.who.int/publications-detail/optimized-supportive-care-for-ebola-virus-disease [146]World Health Organization. Clinical management of patients with viral haemorrhagic fever: a pocket guide for the front-line health worker. February 2016 [internet publication]. https://apps.who.int/iris/bitstream/10665/205570/1/9789241549608_eng.pdf?ua=1
第一选择
地西泮: 儿童：咨询专科医生，获得剂量指导；成人：初始剂量 5-10 mg，静脉使用/肌内注射，需要时每 10-15 分钟重复给药一次，最大总剂量为 30 mg
或
地西泮直肠给药: 儿童：咨询专科医生，获得剂量指导；成人：0.2 mg/kg，直肠给药，单次剂量，如果需要，可在 4-12 小时内给予第 2 剂
第二选择
苯巴比妥: 儿童：咨询专科医生，获得剂量指导；成人：初始剂量 10 mg/kg，静脉使用，随后每 30-60 分钟给予 5mg/kg，直至癫痫发作得到控制，最大总负荷剂量为 30 mg/kg
针对特定患者群中所有患者的治疗建议
虽然不常见，激越可能与脑部具有相关性，或可能由埃博拉病毒直接作用于大脑引起，可见于晚期疾病。
谨慎使用镇静剂（例如氟哌啶醇或苯二氮卓类药物）对保持患者镇静，以及预防医疗保健工作人员针刺伤是必要的。[138]World Health Organization. Optimized supportive care for Ebola virus disease. July 2019 [internet publication]. https://www.who.int/publications-detail/optimized-supportive-care-for-ebola-virus-disease [146]World Health Organization. Clinical management of patients with viral haemorrhagic fever: a pocket guide for the front-line health worker. February 2016 [internet publication]. https://apps.who.int/iris/bitstream/10665/205570/1/9789241549608_eng.pdf?ua=1
根据临床反应给予重复剂量。
第一选择
地西泮: 儿童：咨询专家以获得剂量指导；成人：5 mg，口服/静脉使用，单次给药
或
氟哌啶醇: 儿童：咨询专家以获得剂量指导；成人：5 mg，肌内注射，单次给药
针对特定患者群中所有患者的治疗建议
应逐渐调整供氧，维持 SpO2 >94%。应评估患者是否存在肺炎、容量超负荷、喘鸣和充血性心力衰竭，并相应予以治疗。[138]World Health Organization. Optimized supportive care for Ebola virus disease. July 2019 [internet publication]. https://www.who.int/publications-detail/optimized-supportive-care-for-ebola-virus-disease [146]World Health Organization. Clinical management of patients with viral haemorrhagic fever: a pocket guide for the front-line health worker. February 2016 [internet publication]. https://apps.who.int/iris/bitstream/10665/205570/1/9789241549608_eng.pdf?ua=1
针对特定患者群中所有患者的治疗建议
应使用确立的标准迅速识别脓毒症或脓毒性休克。治疗遵循与细菌性脓毒症治疗相同的原则。应遵循当地指导，但应包括：广谱经验性抗生素治疗，理想的做法是在识别后一小时内给予；快速进行静脉输液复苏，并评估患者反应；以及合理的气道管理和氧疗。[147]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11): e1063-e1143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com
血乳酸水平检测是一种有帮助的工具，有助于评估灌注程度和对复苏的反应。
如果患者对初始治疗无反应，应考虑使用正性肌力药，最好在重症监护病房经中心静脉导管给予，在重症监护病房的有创监测使得可以更积极地纠正液体、电解质和酸碱平衡紊乱。[112]Fowler RA, Fletcher T, Fischer WA 2nd, et al. Caring for critically ill patients with Ebola virus disease. Perspectives from West Africa. Am J Respir Crit Care Med. 2014 Oct 1;190(7):733-7. https://www.atsjournals.org/doi/full/10.1164/rccm.201408-1514CP#.VEe1OvldWnA http://www.ncbi.nlm.nih.gov/pubmed/25166884?tool=bestpractice.com [136]Canadian Critical Care Society; Canadian Association of Emergency Physicians; Association of Medical Microbiology and Infectious Diseases of Canada. Ebola clinical care guidelines: a guide for clinicians in Canada. October 2014 [internet publication]. https://www.canadiancriticalcare.org/resources/Pictures/Ebola%20Clinical%20Care%20Guidelines_ENG.pdf
应考虑出血的可能性，尤其是在皮肤或黏膜出血的患者中。
应参阅世界卫生组织的相关指南，以了解有关脓毒症/脓毒症休克治疗的具体建议。
WHO: optimized supportive care for Ebola virus disease Opens in new window
针对特定患者群中所有患者的治疗建议
多器官功能障碍是晚期感染的常见症状，包括急性肾损伤、胰腺炎、肾上腺衰竭和肝损伤。
肝损伤（例如肝炎）常见；然而，黄疸并不常见。[68]Fletcher T, Fowler RA, Beeching NJ. Understanding organ dysfunction in Ebola virus disease. Intensive Care Med. 2014 Dec;40(12):1936-9. http://www.ncbi.nlm.nih.gov/pubmed/25366120?tool=bestpractice.com
肾功能障碍常见于晚期，但是在初期通过使用充足的液体复苏能使其逆转。[68]Fletcher T, Fowler RA, Beeching NJ. Understanding organ dysfunction in Ebola virus disease. Intensive Care Med. 2014 Dec;40(12):1936-9. http://www.ncbi.nlm.nih.gov/pubmed/25366120?tool=bestpractice.com 在对液体复苏无反应的无尿患者中，已经在应用肾替代疗法，但没有任何试验数据支持这种干预的有效性。在欧洲和北美 5 名多器官衰竭的重症患者接受了有创机械通气和肾脏替代治疗，其中有 3 例患者死亡。[45]Kreuels B, Wichmann D, Emmerich P, et al. A case of severe Ebola virus infection complicated by gram-negative septicemia. N Engl J Med. 2014 Dec 18;371(25):2394-401. https://www.nejm.org/doi/full/10.1056/NEJMoa1411677#t=article http://www.ncbi.nlm.nih.gov/pubmed/25337633?tool=bestpractice.com [104]Lyon GM, Mehta AK, Varkey JB, et al; Emory Serious Communicable Diseases Unit. Clinical care of two patients with Ebola virus disease in the United States. N Engl J Med. 2014 Dec 18;371(25):2402-9. https://www.nejm.org/doi/full/10.1056/NEJMoa1409838#t=article http://www.ncbi.nlm.nih.gov/pubmed/25390460?tool=bestpractice.com [129]Wolf T, Kann G, Becker S, et al. Severe Ebola virus disease with vascular leakage and multiorgan failure: treatment of a patient in intensive care. Lancet. 2015 Apr 11;385(9976):1428-35. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2962384-9/fulltext http://www.ncbi.nlm.nih.gov/pubmed/25534190?tool=bestpractice.com [131]Uyeki TM, Mehta AK, Davey RT Jr, et al. Clinical management of Ebola virus disease in the United States and Europe. N Engl J Med. 2016 Feb 18;374(7):636-46. https://www.nejm.org/doi/full/10.1056/NEJMoa1504874#t=article http://www.ncbi.nlm.nih.gov/pubmed/26886522?tool=bestpractice.com [150]Connor MJ Jr, Kraft C, Mehta AK, et al. Successful delivery of RRT in Ebola virus disease. J Am Soc Nephrol. 2015 Jan;26(1):31-7. http://www.ncbi.nlm.nih.gov/pubmed/25398785?tool=bestpractice.com
针对特定患者群中所有患者的治疗建议
大出血不常发生，但却是严重感染的表现，严重感染通常为致死性，但并非每次都是致命的。
若条件允许，应根据当地政策给予新鲜全血或血小板和血浆，并由临床指标和实验室（若有条件的话）指标（如血红蛋白、红细胞比容、国际标准化比值）指导后续治疗。[138]World Health Organization. Optimized supportive care for Ebola virus disease. July 2019 [internet publication]. https://www.who.int/publications-detail/optimized-supportive-care-for-ebola-virus-disease [146]World Health Organization. Clinical management of patients with viral haemorrhagic fever: a pocket guide for the front-line health worker. February 2016 [internet publication]. https://apps.who.int/iris/bitstream/10665/205570/1/9789241549608_eng.pdf?ua=1 [148]Wada H, Thachil J, Di Nisio M, et al. Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines. J Thromb Haemost. 2013 Feb 4;11(4):761-7. https://onlinelibrary.wiley.com/doi/10.1111/jth.12155/full http://www.ncbi.nlm.nih.gov/pubmed/23379279?tool=bestpractice.com
对于正在出血的患者，使用维生素 K、氨甲环酸或质子泵抑制剂（用于消化道出血）是合理的治疗选择。[138]World Health Organization. Optimized supportive care for Ebola virus disease. July 2019 [internet publication]. https://www.who.int/publications-detail/optimized-supportive-care-for-ebola-virus-disease [146]World Health Organization. Clinical management of patients with viral haemorrhagic fever: a pocket guide for the front-line health worker. February 2016 [internet publication]. https://apps.who.int/iris/bitstream/10665/205570/1/9789241549608_eng.pdf?ua=1
第一选择
维生素 K1: 咨询专科医生，获得剂量指导
或
氨甲环酸: 咨询专科医生，获得剂量指导
或
奥美拉唑: ≥10 岁的儿童和成人：20 mg/天，口服，每日一次
针对特定患者群中所有患者的治疗建议
应进行疟疾诊断试验，如果存在疟疾，立即给予适当的抗疟疾治疗，同时应记住患者存在埃博拉病毒感染风险和双重感染的可能性。在流行区，常规治疗方案通常包括抗疟疾治疗（不论是否确诊有该感染）。
给予经验性抗生素治疗，直至疟疾检测呈阴性或疗程结束。[138]World Health Organization. Optimized supportive care for Ebola virus disease. July 2019 [internet publication]. https://www.who.int/publications-detail/optimized-supportive-care-for-ebola-virus-disease
针对特定患者群中所有患者的治疗建议
WHO 推荐对孕妇采取以下主要管理原则：同时使用标准预防措施和针对埃博拉病毒感染的防控措施；包括在对所有孕妇的临床管理中优化支持性治疗；在严谨研究背景下或者依照当地规程，可给予孕妇 atoltivimab/maftivimab/odesivimab 和 ansuvimab；对于急性感染孕妇，不应由于胎儿指征而进行引产或实施有创操作；疑似或确诊急性感染的女性，建议不哺乳，直至相隔 24 小时的两次母乳检测（RT-PCR 检测）结果呈阴性（同时，婴儿应与母体分离，并给予合适的母乳替代物）。[84]World Health Organization. Guidelines for the management of pregnant and breastfeeding women in the context of Ebola virus disease. 2020 [internet publication]. https://www.who.int/reproductivehealth/publications/ebola-pregnant-and-breastfeeding-women/en
感染后分娩期出血和自然流产似乎常见；因此，产科管理应注重监测并及早治疗出血性并发症。[21]Chertow DS, Kleine C, Edwards JK, et al. Ebola virus disease in West Africa - clinical manifestations and management. N Engl J Med. 2014 Nov 27;371(22):2054-7. https://www.nejm.org/doi/full/10.1056/NEJMp1413084 http://www.ncbi.nlm.nih.gov/pubmed/25372854?tool=bestpractice.com [159]Mupapa K, Mukundu W, Bwaka MA, et al. Ebola hemorrhagic fever and pregnancy. J Infect Dis. 1999 Feb;179 Suppl 1:S11-2. https://jid.oxfordjournals.org/content/179/Supplement_1/S11.long http://www.ncbi.nlm.nih.gov/pubmed/9988157?tool=bestpractice.com [161]Jamieson DJ, Uyeki TM, Callaghan WM, et al. What obstetrician-gynecologists should know about Ebola: a perspective from the Centers for Disease Control and Prevention. Obstet Gynecol. 2014 Nov;124(5):1005-10. http://www.ncbi.nlm.nih.gov/pubmed/25203368?tool=bestpractice.com [162]Association of Women's Health, Obstetric and Neonatal Nurses. Ebola: caring for pregnant and postpartum women and newborns in the United States: AWHONN practice brief number 3. J Obstet Gynecol Neonat Nurs. 2015 Jan-Feb;44(1):164-5 https://onlinelibrary.wiley.com/doi/10.1111/1552-6909.12518/full http://www.ncbi.nlm.nih.gov/pubmed/25421426?tool=bestpractice.com [163]Kitching A, Walsh A, Morgan D. Ebola in pregnancy: risk and clinical outcomes. BJOG. 2015 Feb;122(3):287. http://www.ncbi.nlm.nih.gov/pubmed/25585496?tool=bestpractice.com
CDC 已发布孕妇和新生儿诊疗特定指南。
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