危重型新型冠状病毒肺炎机械通气患者成功脱机体会  

Successful extubation experience in treatment of a critical patient with coronavirus disease 2019 by tracheal intubation mechanical ventilation

作　　者：郝泉水 杨亚东[2] 贾丽萍[3] 李先超 胡亮[1] 汪江[2] 吴耀华[1] Hao Quanshui;Yang Yadong;Jia Liping;Li Xianchao;Hu Liang;Wang Jiang;Wu Yaohua(Depurtment of Anesthesiology,Huanggang Central Hospital,Huanggang 438000,Hubei,China;Depanment of Critical Care Medicine,Huanggang Central Hospital,Huanggang 438000,Hubei,China;Department of Respiratory Medicine,Huanggang Central Hospital,Huanggang 438000,Hubei,China)

机构地区：[1]黄冈市中心医院麻醉科,湖北黄冈438000 [2]黄冈市中心医院重症医学科,湖北黄冈438000 [3]黄冈市中心医院呼吸内科,湖北黄冈438000

出　　处：《中国中西医结合急救杂志》2020年第5期524-527,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：湖北省黄冈市科技计划项目(XQYF2019000014);湖北省医药卫生科研基金项目(WJ2016-YZ-11)。

摘　　要：目的 分析危重型新型冠状病毒肺炎(简称新冠肺炎)气管插管机械通气成功脱机患者的救治经过.方法 黄冈市中心医院大别山区域医疗中心2020年2月3日收治1例危重型新冠肺炎患者,介绍临床诊治过程,分享机械通气成功脱机拔管的经验.结果 患者男性,52岁,因"发热10余天"入院,于2020年1月23日以"病毒性肺炎"收入黄州区人民医院治疗,患者诉咳嗽、咳痰,伴畏寒、发热,体温最高达39℃,经治疗病情未见好转,出现胸闷及呼吸困难,遂转入本院大别山区域医疗中心.患者平素居住武汉市,1月22日返回黄冈市;既往有高血压和糖尿病史.入院后影像学检查:胸部CT显示为快速进展的双肺多发磨玻璃样渗出病灶、部分实变,双下肺病变为甚,后期病灶吸收出现纤维条索影.入院第2天检测新型冠状病毒(2019-nCoV)N蛋白(+),2019-nCoVE蛋白(+),患者因呼吸困难加重给予无创呼吸机高流量吸氧,给予心电监护、抗病毒、抗感染、α-干扰素及布地奈德雾化吸入等治疗;入院第4天行气管插管呼吸机辅助呼吸〔同步间歇指令通气-压力支持(SIMV-PSV)〕;入院第8天通气模式转为持续气道正压通气(CPAP),给予清理呼吸道和吸纯氧2min后顺利拔除气管插管,拔管后给予面罩吸氧;入院第14天患者转入普通病房,给予高流量吸氧,继续抗病毒、抗感染、控制血压和血糖、营养支持等对症治疗.入院第10和13天2次2019-nCoV检测均呈阴性;3月18日达到出院标准,准予出院后隔离2周.结论 该例危重型新冠肺炎患者经氧疗、营养支持、降低氧耗、机械通气治疗后成功脱机、拔管,痊愈出院.Objective To analyze the rescue and treatment process of one ceritical patient with coronavirnus disease 2019(COVID-19)sucessfully extubated from tracheal intubation mechanical ventilation.Methods A patient with severe COVID-19 was admitted to Dabieshan Medical Center of Huanggang City,Hubei Province on February 3,2020.The clinical diagnosis and treatment process was introduced,and the experience of mechanical ventilation sucessful off-line extubation was shared.Results The patient,male,52 years old was admitted to Huangzhou District People's Hospital on January 23,2020 due to"fever for 10 days"and suspected as a case with viral pneumonia.The patient complained of cough and expectoration accompanied by chills and fever,and the maximum body temperature was 39℃.After treatmenl,the patient's condition did not improve,resulting in chest distress and dyspnea,so he was transfered to Dabieshan Medical Center.The patient ordinarily lived in W uhan,Hubei Province and returmned to Huanggang on January 22.2020;he had past histories of hypertension and diabetes.Imaging examination after admission:chest CT showed rapid progressive multiple ground glass exudative lesions and partial consolidation in both lungs,the lesions in both lower lungs were particularly more serious,and at late stage,when absorption of lesions took place,fbrous cord shadow appeared.On day 2 after admission,2019 novel coronavirus(2019-nCoV)N proltein(+)and 2019-nCoV E protein(+)were detected.The patient was given high flow oxygen with noninvasive ventilator because of the aggravation of dyspnea,and electrocardiogram monitoring.drugs for antivirus and anti-infection,α-interferon and budesonide inhalation were given.On day 4,tracheal intubation and respirator simultaneous intrmitent mandalory ventilation-pressure support ventilation(SIMV-PSV)were given to assist breathing;on day 8 of admission,the ventilation mode was changed to continuous positive airway pressure(CPAP);after cleaning respiratory tract and inhaling pure oxygen for 2 minutes,the tracheal

关 键 词：新型冠状病毒肺炎 危重型 气管插管 机械通气 

分 类 号：R47[医药卫生—护理学]