新型冠状病毒性肺炎(2019-nCoV)并发急性呼吸衰竭2例诊治分析

Diagnosis and treatment of 2 cases novel coronavirus pneumonia(2019-nCoV)with acute respiratory failure

目的:总结新型冠状病毒性肺炎(2019-nCoV)并发急性呼吸衰竭的诊治经验。方法:回顾性分析2例新型冠状病毒性肺炎(2019-nCoV)患者的临床资料,分析诊断治疗过程。结果:2例患者以低热、干咳、乏力伴全身肌肉酸痛入院;患者病情进展相对迅速,早期出现胸闷及轻微呼吸困难症状,血氧饱和度下降,抗感染治疗无效;血常规淋巴细胞计数均减少;血气分析提示,急性呼吸衰竭;胸部CT提示双肺多发小斑片影及间质性改变并多发磨玻璃影、浸润影,以肺外缘为主,多考虑病毒性肺炎,早期给予α-干扰素雾化吸入、力托那韦口服抗病毒、抗菌药物治疗、补液、纠酸等综合治疗后,患者病情好转,胸部CT检查病变部分吸收,甘肃卫健委呼吸道分泌物核酸检测阳性,确诊为新型冠状病毒性肺炎。结论:对低热、干咳伴全身肌肉酸痛、胸部CT提示双肺多发小斑片影及间质性改变并多发磨玻璃影、浸润影、以肺外缘为主,且白细胞及中性粒细胞不高、淋巴细胞计数均减少的患者,在无病毒学诊断依据情况下,及早给予抗病毒为主的综合治疗可达到良好疗效。

Objective:To summarize the experience in the diagnosis and treatment of acute respiratory failure complicated with novel coronavirus pneumonia(2019-nCoV).Methods:We analyzed retrospectively the clinical data of 2 patients with novel coronavirus pneumonia(2019-nCoV),and the process of diagnosis and treatment.Results:2 patients were admitted to hospital with low fever,dry cough,fatigue and myalgia.The disease progressed rapidly.The patients developed chest tightness and mild dyspnea at the early stage.Oxygen saturation decreased,and anti-infection treatment was ineffective.The proportion of lymphocyte showed a decreasing trend in blood analysis,and the lymphocyte count decreased.Blood gas analysis indicated acute respiratory failure.Chest CT showed multiple small patch shadow and peripheral pulmonary interstitial changes and multiple ground glass shadow,infiltrating the shadow in the lungs.The peripheral lung was the main area.Viral pneumonia was considered.After comprehensive treatment aboutα-interferon atomization inhalation,ritonavir oral,antibacterial drugs,maintain water electrolyte balance,correct acidosis,and so on.the patients got better.Lung CT showed lesions absorbed partly.Respiratory secretions nucleic acid testing indicated 2019-nCoV positive in Health commission of Gansu Province.Conclusion:For the patients with low fever,dry cough accompanied by systemic muscle pain,chest CT showed multiple small patch shadows and interstitial changes in peripheral band of both lungs,multiple ground glass shadows and infiltration shadows with main peripheral lung zone,white blood cell and neutrophils normal or lower decreased lymphocyte count,and decreased lymphocyte proportion.In the absence of a virological diagnosis,antiviral comprehensive treatment early can achieve a good result.