新型冠状病毒肺炎并发急性呼吸衰竭3例诊治分析

Diagnosis and treatment of 3 cases of COVID-19 with acute respiratory failure

目的:总结新型冠状病毒肺炎(corona virus disease 2019,COVID-19)并发急性呼吸衰竭的诊治经验。方法:回顾性分析3例COVID-19患者的临床资料,分析其诊断治疗过程。结果:3例患者以低热、干咳、乏力伴全身肌肉酸痛入院;入院后病情进展相对迅速,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;血常规淋巴细胞比例均呈下降趋势,淋巴细胞计数均减少;血气分析提示,急性呼吸衰竭;胸部CT示双肺外周带多发小斑片影及间质性改变并多发磨玻璃影、浸润影,以肺外周带为主,多考虑病毒性肺炎。甘肃卫健委采集呼吸道分泌物核酸检测为阳性。早期给予ɑ-干扰素雾化吸入、利托那韦口服抗病毒、抗菌药物治疗,补液、纠酸等综合治疗后,患者病情好转,影像学CT检查示病变部分吸收,出院后严密观察病情,及时复诊并居家隔离14 d。结论:对低热、干咳伴全身肌肉酸痛、胸部CT提示双肺外周带多发小斑片影及间质性改变并多发磨玻璃影、浸润影,以肺外周带为主,且白细胞及中性粒细胞、淋巴细胞计数均减少、淋巴细胞比例均呈下降趋势的患者,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 corona virus disease 2019(COVID-19)complicated with acute respiratory failure.Methods:The clinical data of 3 patients with COVID-19 were analyzed retrospectively and the process of diagnosis and treatment were also analyzed.Results:Three patients were admitted to hospital with low fever,dry cough,fatigue and myalgia.The disease progressed rapidly.There were some symptoms such as chest tightness and mild dyspnea at early stage,oxygen saturation drops,and ineffective anti-infection treatment.The proportion of lymphocyte showed a decreasing trend in blood routine examination,and the lymphocyte counts 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,and the peripheral lung was the main area.Thinking of it as viral pneumonia,respiratory secretions nucleic acid testing indicated COVID-19 in health commission of Gansu province.The patients were given comprehensive treatment aboutɑ-interferon atomization inhalation,ritonavir oral,antibacterial drugs,maintain water electrolyte balance,correct acidosis,and so on.After treatment,the patient got better,and lung CT showed lesions have been absorbed partly,after discharge,the patients were observed and returned to the hospital in time,home isolation observation for 14 d.Conclusion:For the patients with low fever,dry cough accompanied by systemic muscle pain,chest CT show multiple small patch shadows and interstitial changes in peripheral band of both lungs,multiple ground glass shadows and infiltration shadows with mainly peripheral lung zone,white blood cell and neutrophils normal or lower,lymphocyte counts and lymphocyte proportion are decreased.In the absence of a virological diagnosis,antiviral comprehensive treatment early can achieve a good result.