1例典型危重型新型冠状病毒肺炎病例治疗经验  

Clinical treatment experience of one critically ill patient with typical COVID-19

作　　者：胡哲夫[1] 周晨亮[1] 唐其柱[1] 严娟娟[1] 孙丽芳[1] 程丽 徐平英 魏捷[1] 牛志力 王鑫[3] HU Zhe-fu;ZHOU Chen-liang;TANG Qi-zhu;YAN Juan-juan;SUN Li-fang;CHENG Li;XU Ping-ying;WEI Jie;NIU Zhi-li;WANG Xin(REN MIN Hospital of Wuhan University,Wuhan,Hubei 430060,China)

机构地区：[1]武汉大学人民医院东院重症医学科,湖北武汉430060 [2]武汉大学人民医院东院检验科,湖北武汉430060 [3]新疆医科大学第一附属医院重症医学科,新疆乌鲁木齐830054

出　　处：《中华医院感染学杂志》2020年第13期1960-1963,共4页Chinese Journal of Nosocomiology

摘　　要：目的探讨新型冠状病毒肺炎(COVID-19)疫情早期医院收治的1例典型危重型患者的临床治疗经验。方法回顾性分析武汉大学人民医院东院重症医学科2020年2月25日收治的1例危重型COVID-19患者的临床资料,用描述性方法对患者入院后的病情、化验结果及影像学资料进行分析总结。结果患者胸部CT平扫示双肺多发感染性病变,后续查咽拭子新型冠状病毒核酸阳性,外周血白细胞计数(WBC)、淋巴细胞(LYM)、白介素-6(IL-6)、降钙素原(PCT)、细胞及体液免疫等指标随治疗进展呈现动态变化。患者于2月27日及2月28日两次复查病毒转阴,于3月4日开始拟脱机治疗,以有创通气与高流量湿化给氧交替治疗,目前已成功脱机拔管,肺部感染较前明显吸收。主要治疗方案为抗菌药物、抗病毒、激素的使用、呼吸支持、丙种球蛋白提高免疫、营养支持、脏器功能维护、稳定内环境、呼吸肌康复训练及密切的护理等。患者病毒核酸转阴,并成功脱机拔管,病情恢复。结论COVID-19是一种危害极大的新型病毒性疾病,危重患者若合并呼吸衰竭及多脏器功能异常,需给予积极的呼吸支持手段,并密切评估患者病情以动态调整治疗方案,实施脏器功能保护达到高级生命支持的目的。OBJECTIVE To explore the experience of treatment of one critically ill patient with Corona Virus Disease 2019(COVID-19)in early stage.METHODS The clinical data of one critically ill patient with COVID-19 who was treated Renmin Hospital of Wuhan University on Feb.25,2020.was retrospectively analyzed,and the illness condition,results of clinical laboratory tests and imaging data of the patient were descriptively analyzed and summarized after the patient was hospitalized.RESULTS The chest CT scan of the patient showed that there were multiple infectious lesions in both lungs,the throat swab was successively tested positive for 2019-nCoV nucleic acid,and the peripheral blood white blood cell(WBC)count,lymphocyte(LYM),interleukin-6(IL-6),procalcitonin(PCT)and cellular and humoral immunity indexes showed dynamic changes with the progress of treatment.The patient was tested twice negative for the virus on Feb 27 and Feb 28 and was given offline treatment on Mar 4 and alternate treatment of invasive ventilation and high flow humidification oxygen therapy,at present,the patient could breathe autonomously without any respiratory support,and the pulmonary infection was improved dramatically.The main treatment plans were the antibiotic therapy,antiviral therapy,use of hormones,respiratory support,gamma globulin,nutritional support,maintenance of organ function,stabilization of internal environment,rehabilitation of respiratory muscle and close nursing.The patient was tested negative for the nucleic acid of the virus and succeeded in offline treatment and extubation,and the illness condition was recovered.CONCLUSION COVID-19 is an extremely harmful and novel viral disease.It is necessary to carry out active respiratory support means for the critically ill patient who is complicated with respiratory failure and multiple organ dysfunction,dynamically adjust the treatment plans by closely evaluating the illness condition of the patient and protect the organ function so as to achieve the purpose of advanced life support.

关 键 词：重症医学 新型冠状病毒肺炎 呼吸支持 高级生命支持 

分 类 号：R563.1[医药卫生—呼吸系统]