肺癌围手术期合并新型冠状病毒肺炎一例

Novel coronavirus pneumonia(COVID-19)after pulmonary surgery:A case report

患者,男,61岁,肺癌术后合并新型冠状病毒(2019-nCoV,SARS-CoV-2)肺炎,术前无明确新型冠状病毒肺炎接触史。患者术后第4 d出现一过性发热,调整抗生素后第5 d体温恢复正常,术后6 d再次出现发热伴乏力,查胸部CT提示术后肺炎。加用更昔洛韦及盐酸莫西沙星。术后7~9 d患者体温逐渐下降,第10 d复查CT提示病毒性肺炎,遂立即提升防护等级。患者新型冠状病毒核酸检测阳性,即刻转入定点医院救治,予以阿比多尔、莫西沙星、人免疫球蛋白(PH4)、氨溴索及其他营养对症支持治疗,目前病情平稳。与患者密切接触人员中共10人出现症状,CT均提示病毒性肺炎,其中6人行新型冠状病毒核酸检测提示阳性,其他人继续隔离观察。由此可见肺癌术后肺炎与新型冠状病毒肺炎两者影像学表现较易混淆,应在CT早期尽快行新型冠状病毒核酸检测确诊,应结合疫情重新制定治疗方案。

There was a male novel coronavirus(2019-nCoV,SARS-CoV-2)pneumonia(COVID-19)patient after pulmonary surgery at age of 61 years.The patient had no clear history of contact COVID-19 patient before surgery.He developed transient fever on the 4 th day after surgery.The body temperature returned to normal on the 5 th day after antibiotic adjustment.The patient developed fever and fatigue again on the 6 th day after surgery.A chest CT scan revealed postoperative pneumonia.The patient was treated by ganciclovir and moxifloxacin hydrochloride.The patient’s temperature gradually decreased on the 7 th to 9 th days after the operation.CT scan on the 10 th day after surgery showed viral pneumonia,so we immediately raised the level of protection.The novel coronavirus nucleic acid test was positive.The patient was immediately transferred to the designated hospital for treatment.The patient was treated by arbidol,moxifloxacin,human immunoglobulin(PH4),ambroxol and other nutritional symptomatic and supportive treatment.The patient’s condition is currently stable.Ten people in close contact with the patient developed symptoms,and their CT scans showed viral pneumonia.Six of them were positive in nucleic acid tests,and the others were still under quarantine observation.This shows that it is easy to confuse the imaging manifestations of pneumonia with novel coronavirus pneumonia after lung surgery.We should perform nucleic acid detection as soon as possible in the early diagnosis of CT and reformulate the treatment protocol.