免疫功能正常宿主重症病毒性肺炎诊治体会

The Experience of Diagnosis and Treatment of Severe Viral Pneumonia Caused by Immunocompetent Hosts

免疫功能正常宿主发生的病毒性肺炎病情进展非常迅速,很快发展为急性呼吸窘迫综合征和多器官功能障碍。近期本院诊治2例重症病毒性肺炎伴ARDS患者,1例死亡、1例康复。在诊疗过程中早期诊断是关键,有发热和典型的影像学表现时就应该及时采取经验性抗病毒治疗,同时留取鼻咽部分泌物标本送病毒学检测。并发ARDS时无创机械通气应早期使用,使用的目标是保障氧合,强调患者的依从性,保证持续性的PEEP存在。激素的使用存在争议,早期使用有可能改善预后。对于不能完全排除细菌感染的病例仍然需要使用抗菌药物,没有相关危险因素时不必覆盖铜绿假单胞菌。基础疾病多可能影响疾病的预后。

Progression of viral pneumonia in immunocompetent hosts often occur very rapidly,and soon developed into acute respiratory distress syndrome and multiple organ dysfunction.Recently there were two cases of severe viral pneumonia in patients with ARDS our hospital,one case died,one case of recovery.In the treatment process the key is early diagnosis,when fever and typical imaging findings should be timely empiric antiviral therapy,while specimens from nasopharyngeal secretions were sent to virology testing.Early noninvasive mechanical ventilation should be used to protect oxygenation if concurrent ARDS,emphasizing patient compliance,to ensure continuity of PEEP.There are disputed of the hormones,the early use may improve the prognosis.For the cases not completely rule out bacterial infections still need to use antibiotics,and not to cover the Pseudomonas aeruginosa in the lower risk factors.Underlying diseases may affect the prognosis of the disease.