流感作为我国重大公共卫生挑战之一，其高发病率与高疾病负担对防控工作提出紧迫要求。近日，由中国医师协会急诊医师分会、中华医学会急诊医学分会、北京急诊医学学会、解放军急救医学专业委员会联合修订的《成人流行性感冒诊疗规范急诊专家共识（2025版）》正式发布。此次共识是对2022版的重要迭代与深化，系统整合了近年来循证医学关键进展，聚焦于快速诊断技术的临床落地、新型抗病毒药物的规范化引入、以及中医药治疗的循证升级等核心环节，旨在构建更具响应力与实效性的急诊流感诊疗体系，为应对当前流感防控形势提供权威、前沿的临床指引。
一、快速检测，抢黄金救治：
核酸检测革新急诊流程
流感多在冬春季发病，因地域差异亦可全年发病。流感患者常有发热、肌肉疼痛、头痛、倦怠等全身症状，而咽痛、流涕和鼻塞等局部症状轻微。流感病毒引发多种并发症，并加重慢性基础疾病（推荐意见1-2）。
面对流感严峻形势，早期快速诊断是有效干预的前提，诊断前移与精准化成为核心策略。与传统的病毒分离培养（金标准但耗时长）［1-3］或血清学检测（对早期诊断价值有限）［4］相比，快速核酸检测在急诊情境下的优势明显，目前已逐步发展成为临床诊断中首选检测手段［5-6］。同时共识指出，快速抗原检测操作简便，适合即时检验，但敏感性低于PCR核酸检测，阴性结果不能排除感染，建议进一步通过PCR核酸检测以明确诊断。这一诊断策略的更新，体现了急诊医学对“时间窗”概念的重视，为后续的早期抗病毒治疗奠定了关键基础。共识推荐首选上呼吸道鼻咽样本进行RT-PCR检测流感病毒核酸。在无法进行核酸检测的情况下可采用抗原检测作为替代。在条件允许的情况下，推荐不同的检测方法组合应用以提高检测准确性（推荐意见4）。同时临床上需高度警惕流感病毒合并其他类型病原体混合感染，积极进行病原学的诊断与鉴别诊断（推荐意见5）。
图1 流感诊断和病情评估流程
二、拓新版图，注民族力量：
抗流感新药纳入权威共识
抗流感病毒药物分为 NAIs、RNA聚合酶抑制剂、血凝素抑制剂，对目前流行的甲型和乙型流感病毒均具有较高的敏感性，且安全性良好。(证据等级Ⅱ，推荐强度 B)（推荐意见 8）
图2抗病毒药物靶向作用机制
01
治疗方案
共识对抗病毒药物章节进行重要扩充，重点纳入近年来我国自主研发获批上市的新型抗流感药物，特别是RNA聚合酶抑制剂，此类药物通过抑制流感病毒RNA聚合酶复合体的不同亚基干扰病毒复制，包括靶向PA亚基的药物玛舒拉沙韦、玛硒洛沙韦；靶向PB2亚基的药物昂拉地韦。
在无并发症的青少年或成人流感患者（甲型流感99.9%）中开展的一项Ⅲ期RCT试验结果显示，玛舒拉沙韦与安慰剂相比可显著缩短流感症状持续时间（42.0 h vs. 63.0 h，P=0.002）和中位退热时间（19.7 h vs. 28.3 h，P = 0.009），病毒排毒停止中位时间为22 h（P<0.001）[7]。同时玛舒拉沙韦Ⅱ期研究是在唯一以乙型流感为主( 99.5% )的无并发症成人流感患者中开展的RCT，其结果与Ⅲ期结果类似，40 mg 玛舒拉沙韦同样可减少流感症状持续时间( 50.0 h vs．安慰剂 82.3 h) 和中位退热时间( 27.0 h vs．47.2 h)，病毒排毒停止中位时间为 23.5 h［8］。
在甲型和乙型流感的用药方案选择上，目前已上市的抗病毒药物多数对甲型和乙型流感均有明显疗效［7-17］，其中昂拉地韦目前获批用于甲型流感患者［18］。考虑到服药的便捷性和用药依从性，推荐优先选择口服片剂的抗病毒药物( 按上市顺序) :奥司他韦、玛巴洛沙韦［14、19］、玛舒拉沙韦［7-8］、昂拉地韦［18］( 仅用于甲型流感) 、玛硒洛沙韦［15］ 等。抗病毒治疗疗程一般为 5～7 天，疗程结束后若症状仍未缓解、有病毒复制依据或有免疫抑制状态时，可考虑延长抗病毒疗程至 10～14 天［20-21］; 有条件者应考虑进行耐药性检测以及时调整用药方案［22］。
02
应用时机
急诊非重症流感患者在病原学确诊后应及时给予抗病毒治疗。普通型流感( 非妊娠女性)、无重症高危因素者，需充分评估抗病毒治疗的风险和收益。而急诊重症及危重症流感患者应在发病 48 小时内启动抗病毒治疗［23-24］，延长启动可能会增加重症率和病死率［25-26］，尽早启动( 如 36 小时内) 可进一步降低下呼吸道感染风险［9］; 该类患者启动抗病毒治疗无需等待病原学确诊结果，但基于多病原合并感染带来的流感重症风险［27，28］，仍建议及时进行病原学检测以指导治疗。发病超过 48 小时的急诊重症及危重症患者，仍需予以抗病毒治疗［9］。
由于 NAIs、血凝素抑制剂和RNA聚合酶抑制剂之间作用机制不同，目前尚未观察到靶点相关的交叉耐药现象。因此，若流感病毒对某一类( 或某一靶点) 抗病毒药物的敏感性下降，可考虑换用作用机制不同的其他类别药物治疗［29］。
三、中西合璧，推循证革新：
新版共识推动中西医并重抗流感
共识延续了“中西医并重”的诊疗原则，并对中药及中成药的应用进行了循证依据的更新。抗流感病毒的中药或中成药具有多靶点、耐药性低和退热效果佳等特点，根据临床表现辨证论治，在缓解流感症状、减少重症和缩短住院时间等方面具有一定优势（推荐意见10）。
总之，2025版共识系统更新了成人流感的诊疗与预防策略，为急诊实现早期识别与规范治疗提供实用指导。未来需通过研发广谱疫苗、新型药物与便捷诊断工具应对病毒变异挑战，并重点优化重症预警、个体化治疗与真实世界研究，同时强化多学科协作与资源整合，以全面提升我国流感诊疗的规范化与同质化水平。
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