三例非免疫缺陷出现急性呼吸窘迫综合征的重症腺病毒肺炎患者临床诊治

Clinical diagnosis and treatment of severe adenovirus pneumonia with ARDS:three cases report and literature review

目的 探讨短时间出现严重急性呼吸窘迫综合征的重症腺病毒肺炎患者的临床诊治及减少康复后的并发症。方法 分析3例免疫功能正常的重症社区获得性腺病毒肺炎患者的临床资料,实验室检查结果,治疗过程及影像学转归。结果 3例患者均在极短时间内发病并快速进展出现ARDS,均在早期留取了肺泡灌洗液进行宏基因组二代测序,检测出了腺病毒,并立刻使用了抗病毒治疗药物,前两例患者接受了西多福韦抗病毒治疗,第三例患者使用了利巴韦林抗病毒治疗。3例患者均接受了极高的呼吸支持,其中前两例接受了体外膜肺氧合治疗。3例患者治疗后肺部感染均恢复良好。结论 重症腺病毒肺炎的诊治目前仍以个体化对症支持、免疫调节和治疗并发症为主,宏基因组二代测序能尽早确诊和治疗,有利于减少并发症、提高生存率。

Objective To explore the diagnosis and treatment of severe adenovirus pneumonia patients with severe acute respiratory distress syndrome(ARDS)in a short time and reduce the complications after rehabilitation.Methods The clinical data,laboratory results,treatment process and imaging outcomes of three severe communityacquired adenovirus pneumonia patients with normal immune function were analyzed.Results All the three patients developed ARDS in a very short time.In the early stage,alveolar lavage fluid obtained by fiberoptic bronchoscopy was taken for macrogenomic second-generation sequencing(mNGS),adenovirus was detected and antiviral drugs were immediately used.The first two patients received cidofovir antiviral therapy and the third patient received ribavirin antiviral therapy.All three patients received very high respiratory support,of which the first two received extracorporeal membrane oxygenation treatment.The lungs of all three patients recovered well after treatment.Conclusions The diagnosis and treatment of severe adenovirus pneumonia is still based on individualized symptomatic support,immune regulation and treatment of complications.mNGS can help diagnose and direct treatment of adenovirus pneumonia as early as possible,which is beneficial to reduce complications and improve survival rate.