流感作為我國(guó)重大公共衛(wèi)生挑戰(zhàn)之一，其高發(fā)病率與高疾病負(fù)擔(dān)對(duì)防控工作提出緊迫要求。近日，由中國(guó)醫(yī)師協(xié)會(huì)急診醫(yī)師分會(huì)、中華醫(yī)學(xué)會(huì)急診醫(yī)學(xué)分會(huì)、北京急診醫(yī)學(xué)學(xué)會(huì)、解放軍急救醫(yī)學(xué)專業(yè)委員會(huì)聯(lián)合修訂的《成人流行性感冒診療規(guī)范急診專家共識(shí)（2025版）》正式發(fā)布。此次共識(shí)是對(duì)2022版的重要迭代與深化，系統(tǒng)整合了近年來(lái)循證醫(yī)學(xué)關(guān)鍵進(jìn)展，聚焦于快速診斷技術(shù)的臨床落地、新型抗病毒藥物的規(guī)范化引入、以及中醫(yī)藥治療的循證升級(jí)等核心環(huán)節(jié)，旨在構(gòu)建更具響應(yīng)力與實(shí)效性的急診流感診療體系，為應(yīng)對(duì)當(dāng)前流感防控形勢(shì)提供權(quán)威、前沿的臨床指引。

一、快速檢測(cè)，搶黃金救治：

核酸檢測(cè)革新急診流程

流感多在冬春季發(fā)病，因地域差異亦可全年發(fā)病。流感患者常有發(fā)熱、肌肉疼痛、頭痛、倦怠等全身癥狀，而咽痛、流涕和鼻塞等局部癥狀輕微。流感病毒引發(fā)多種并發(fā)癥，并加重慢性基礎(chǔ)疾病（推薦意見(jiàn)1-2）。

面對(duì)流感嚴(yán)峻形勢(shì)，早期快速診斷是有效干預(yù)的前提，診斷前移與精準(zhǔn)化成為核心策略。與傳統(tǒng)的病毒分離培養(yǎng)（金標(biāo)準(zhǔn)但耗時(shí)長(zhǎng)）［1-3］或血清學(xué)檢測(cè)（對(duì)早期診斷價(jià)值有限）［4］相比，快速核酸檢測(cè)在急診情境下的優(yōu)勢(shì)明顯，目前已逐步發(fā)展成為臨床診斷中首選檢測(cè)手段［5-6］。同時(shí)共識(shí)指出，快速抗原檢測(cè)操作簡(jiǎn)便，適合即時(shí)檢驗(yàn)，但敏感性低于PCR核酸檢測(cè)，陰性結(jié)果不能排除感染，建議進(jìn)一步通過(guò)PCR核酸檢測(cè)以明確診斷。這一診斷策略的更新，體現(xiàn)了急診醫(yī)學(xué)對(duì)“時(shí)間窗”概念的重視，為后續(xù)的早期抗病毒治療奠定了關(guān)鍵基礎(chǔ)。共識(shí)推薦首選上呼吸道鼻咽樣本進(jìn)行RT-PCR檢測(cè)流感病毒核酸。在無(wú)法進(jìn)行核酸檢測(cè)的情況下可采用抗原檢測(cè)作為替代。在條件允許的情況下，推薦不同的檢測(cè)方法組合應(yīng)用以提高檢測(cè)準(zhǔn)確性（推薦意見(jiàn)4）。同時(shí)臨床上需高度警惕流感病毒合并其他類型病原體混合感染，積極進(jìn)行病原學(xué)的診斷與鑒別診斷（推薦意見(jiàn)5）。

圖1 流感診斷和病情評(píng)估流程

二、拓新版圖，注民族力量：

抗流感新藥納入權(quán)威共識(shí)

抗流感病毒藥物分為 NAIs、RNA聚合酶抑制劑、血凝素抑制劑，對(duì)目前流行的甲型和乙型流感病毒均具有較高的敏感性，且安全性良好。(證據(jù)等級(jí)Ⅱ，推薦強(qiáng)度 B)（推薦意見(jiàn) 8）

圖2抗病毒藥物靶向作用機(jī)制

01

治療方案

共識(shí)對(duì)抗病毒藥物章節(jié)進(jìn)行重要擴(kuò)充，重點(diǎn)納入近年來(lái)我國(guó)自主研發(fā)獲批上市的新型抗流感藥物，特別是RNA聚合酶抑制劑，此類藥物通過(guò)抑制流感病毒RNA聚合酶復(fù)合體的不同亞基干擾病毒復(fù)制，包括靶向PA亞基的藥物瑪舒拉沙韋、瑪硒洛沙韋；靶向PB2亞基的藥物昂拉地韋。

在無(wú)并發(fā)癥的青少年或成人流感患者（甲型流感99.9%）中開(kāi)展的一項(xiàng)Ⅲ期RCT試驗(yàn)結(jié)果顯示，瑪舒拉沙韋與安慰劑相比可顯著縮短流感癥狀持續(xù)時(shí)間（42.0 h vs. 63.0 h，P=0.002）和中位退熱時(shí)間（19.7 h vs. 28.3 h，P?=?0.009），病毒排毒停止中位時(shí)間為22 h（P<0.001）[7]。同時(shí)瑪舒拉沙韋Ⅱ期研究是在唯一以乙型流感為主( 99.5% )的無(wú)并發(fā)癥成人流感患者中開(kāi)展的RCT，其結(jié)果與Ⅲ期結(jié)果類似，40 mg 瑪舒拉沙韋同樣可減少流感癥狀持續(xù)時(shí)間( 50.0 h vs．安慰劑 82.3 h) 和中位退熱時(shí)間( 27.0 h vs．47.2 h)，病毒排毒停止中位時(shí)間為 23.5 h［8］。

在甲型和乙型流感的用藥方案選擇上，目前已上市的抗病毒藥物多數(shù)對(duì)甲型和乙型流感均有明顯療效［7-17］，其中昂拉地韋目前獲批用于甲型流感患者［18］�？紤]到服藥的便捷性和用藥依從性，推薦優(yōu)先選擇口服片劑的抗病毒藥物( 按上市順序) :奧司他韋、瑪巴洛沙韋［14、19］、瑪舒拉沙韋［7-8］、昂拉地韋［18］( 僅用于甲型流感) 、瑪硒洛沙韋［15］ 等�？共《局委煰煶桃话銥� 5～7 天，療程結(jié)束后若癥狀仍未緩解、有病毒復(fù)制依據(jù)或有免疫抑制狀態(tài)時(shí)，可考慮延長(zhǎng)抗病毒療程至 10～14 天［20-21］; 有條件者應(yīng)考慮進(jìn)行耐藥性檢測(cè)以及時(shí)調(diào)整用藥方案［22］。

02

應(yīng)用時(shí)機(jī)

急診非重癥流感患者在病原學(xué)確診后應(yīng)及時(shí)給予抗病毒治療。普通型流感( 非妊娠女性)、無(wú)重癥高危因素者，需充分評(píng)估抗病毒治療的風(fēng)險(xiǎn)和收益。而急診重癥及危重癥流感患者應(yīng)在發(fā)病 48 小時(shí)內(nèi)啟動(dòng)抗病毒治療［23-24］，延長(zhǎng)啟動(dòng)可能會(huì)增加重癥率和病死率［25-26］，盡早啟動(dòng)( 如 36 小時(shí)內(nèi)) 可進(jìn)一步降低下呼吸道感染風(fēng)險(xiǎn)［9］; 該類患者啟動(dòng)抗病毒治療無(wú)需等待病原學(xué)確診結(jié)果，但基于多病原合并感染帶來(lái)的流感重癥風(fēng)險(xiǎn)［27，28］，仍建議及時(shí)進(jìn)行病原學(xué)檢測(cè)以指導(dǎo)治療。發(fā)病超過(guò) 48 小時(shí)的急診重癥及危重癥患者，仍需予以抗病毒治療［9］。

由于 NAIs、血凝素抑制劑和RNA聚合酶抑制劑之間作用機(jī)制不同，目前尚未觀察到靶點(diǎn)相關(guān)的交叉耐藥現(xiàn)象。因此，若流感病毒對(duì)某一類( 或某一靶點(diǎn)) 抗病毒藥物的敏感性下降，可考慮換用作用機(jī)制不同的其他類別藥物治療［29］。

三、中西合璧，推循證革新：

新版共識(shí)推動(dòng)中西醫(yī)并重抗流感

共識(shí)延續(xù)了“中西醫(yī)并重”的診療原則，并對(duì)中藥及中成藥的應(yīng)用進(jìn)行了循證依據(jù)的更新�？沽鞲胁《镜闹兴幓蛑谐伤幘哂卸喟悬c(diǎn)、耐藥性低和退熱效果佳等特點(diǎn)，根據(jù)臨床表現(xiàn)辨證論治，在緩解流感癥狀、減少重癥和縮短住院時(shí)間等方面具有一定優(yōu)勢(shì)（推薦意見(jiàn)10）。

總之，2025版共識(shí)系統(tǒng)更新了成人流感的診療與預(yù)防策略，為急診實(shí)現(xiàn)早期識(shí)別與規(guī)范治療提供實(shí)用指導(dǎo)。未來(lái)需通過(guò)研發(fā)廣譜疫苗、新型藥物與便捷診斷工具應(yīng)對(duì)病毒變異挑戰(zhàn)，并重點(diǎn)優(yōu)化重癥預(yù)警、個(gè)體化治療與真實(shí)世界研究，同時(shí)強(qiáng)化多學(xué)科協(xié)作與資源整合，以全面提升我國(guó)流感診療的規(guī)范化與同質(zhì)化水平。

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