新型冠状病毒肺炎并发气胸的临床特征:附7例分析  

Clinical characteristics of coronavirus disease 2019 patients complicated with pneumothorax:analysis of 7 cases

作　　者：贾丽萍[1] 王昌锋[1] 张玉娇 叶媛媛[1] 金朝霞[2] Jia Liping;Wang Changfeng;Zhang Yujiao;Ye Yuanyuan;Jin Zhaoxia(Department of Respiratory and Critical Care Medicine,Huanggang Central Hospital,Huanggang 438000,Hubei,China;Department of Cardiovascular Medicine,Huanggang Central Hospital,Huanggang 438000,Hubei,China)

机构地区：[1]黄冈市中心医院呼吸与危重症医学科,湖北黄冈438000 [2]黄冈市中心医院心血管内科,湖北黄冈438000

出　　处：《中华危重病急救医学》2020年第10期1174-1177,共4页Chinese Critical Care Medicine

基　　金：湖北省黄冈市级科技计划项目(XQYF2020000016)。

摘　　要：目的分析新型冠状病毒肺炎(简称新冠肺炎)并发气胸患者的临床特点及预后。方法回顾性分析黄冈市中心医院2020年1月3日至3月10日收治的7例新冠肺炎并发气胸患者的临床资料,总结临床特点和诊疗情况,分享新冠肺炎的治疗经验。结果①一般资料:7例患者中男性5例,女性2例。其中4例无任何基础疾病,1例有糖尿病和高血压病史;1例仅有高血压病史。发生右侧气胸6例,双侧气胸1例。7例患者住院时间较长,均超过4周,且多合并多器官功能不全。②影像学检查:1例在1周内从早期演变为进展期,2周内演变为重症期,4周后并发气胸,2周内气胸吸收;其余6例入院时即表现为进展期,均在1~2周内进展为重症期,多表现为双肺弥漫性实变影、条索影及纤维化,胸膜粘连明显,病灶吸收极缓慢。③治疗:1例重型患者发病4周后并发气胸,给予无创呼吸机辅助通气治疗;其余6例危重型患者给予气管插管机械通气治疗,机械通气到发生气胸时间在3 d内的有5例,11 d后发生的有1例。④转归:未气管插管的1例患者持续给予经鼻高流量氧疗,病情平稳。6例气管插管后并发气胸患者死亡4例,另2例均在胸腔闭式引流2周内成功拔除引流管,病情逐渐稳定。结论新冠肺炎并发气胸病情凶险且预后差,应予以足够的重视。Objective To analyze the clinical characteristics and prognosis of coronavirus disease 2019(COVID-19)patients complicated with pneumothorax.Methods The clinical data of 7 COVID-19 patients complicated with pneumothorax admitted to Huanggang Central Hospital from January 3 to March 10,2020 were retrospectively analyzed.The clinical features,diagnosis and treatment were summarized,and experience in the treatment of COVID-19 was shared.Results①General information:among the 7 patients,5 were males and 2 were females.Four of them had no underlying disease,and 1 had a history of diabetes and hypertension.One patient had only a history of hypertension.There were 6 cases of right pneumothorax and 1 case of bilateral pneumothorax.The 7 patients had a long hospital stay,all over 4 weeks,mostly complicated with multiple organ dysfunction.②Imaging examination:1 case evolved from the early stage to the advanced stage within 1 week and to the severe stage within 2 weeks.Pneumothorax occurred 4 weeks later,and was absorbed within 2 weeks.The remaining 6 patients presented progressive stage on admission,all of them advanced to severe stage within 1 to 2 weeks,and most of them presented diffused consolidation shadows,striation shadows and fibrosis of both lungs,obvious pleural adhesion,and extremely slow lesion absorption.③Treatment:1 severe patient with pneumothorax 4 weeks after onset was given non-invasive mechanical ventilation.The remaining 6 critically ill patients were treated with endotracheal intubation and mechanical ventilation.Five patients were treated with mechanical ventilation within 3 days after the occurrence of pneumothorax,and 1 patient was treated with mechanical ventilation after 11 days.④Outcome:1 patient without endotracheal intubation was continuously given nasal high-flow oxygen therapy,and the condition was stable.Four of the 6 patients complicated with pneumothorax after endotracheal intubation died,and the other 2 patients successfully removed the drainage tube within 2 weeks of closed thoraci

关 键 词：新型冠状病毒肺炎 气胸 临床特点 

分 类 号：R563.1[医药卫生—呼吸系统] R561.4[医药卫生—内科学]