新型冠状病毒肺炎并发肺动脉高压临床病例分析

Clinical case analysis of novel coronavirus pneumonia complicated with pulmonary hypertension

目的报道5例超声心动图发现的新型冠状病毒肺炎(COVID⁃19)并发肺动脉高压患者的临床特征,了解COVID⁃19的特殊临床表现并探讨可能的机制。方法对2020年2月5日至3月31日首都医科大学附属北京地坛医院超声心动图诊断的COVID⁃19并发肺动脉高压患者的超声心动图影像资料及临床特征进行描述性分析。结果共有15例重型和危重型COVID⁃19患者行超声心动图检查,7例被诊断存在肺动脉高压,其中5例被确认为COVID⁃19的并发症。5例患者中女性4例,男性1例;年龄62~78岁;既往有高血压病者4例,糖尿病者3例,冠状动脉粥样硬化性心脏病者1例。5例均为COVID⁃19危重型患者,均给予呼吸机辅助呼吸,其中2例同时使用体外膜肺氧合(ECMO)支持治疗。经超声心动图计算,5例患者的肺动脉收缩压为43~65 mmHg(1 mmHg=0.133 kPa),平均54 mmHg;肺动脉高压严重程度分级:轻度1例,中度4例。随访过程中,4例患者肺动脉收缩压逐渐降低至正常,撤除呼吸机及ECMO;1例因呼吸衰竭及持续肺动脉高压最终死亡。结论COVID⁃19可并发肺动脉高压,多发于危重型患者。超声心动图是COVID⁃19患者肺动脉高压重要的影像学诊断方法。

Objective To report the clinical features of pulmonary hypertension diagnosed by echocardiography in 5 patients with novel coronavirus pneumonia(COVID-19)in order to understand the special clinical manifestations of COVID-19 and explore the possible mechanism.Methods The echocardiographic data and clinical characteristics of COVID-19 patients complicated with pulmonary hypertension diagnosed by echocardiography in Beijing Ditan Hospital,Capital Medical University were analyzed descriptively from February 5 to March 31,2020.Results A total of 15 patients with severe and critical COVID-19 patients underwent echocardiography.Of them,7 patients were diagnosed with pulmonary hypertension,5 of which were confirmed as complications of COVID-19.Among the 5 patients,4 were female and 1 was male,aged 62-78 years;4 were with hypertension,3 were with diabetes,and 1 was with coronary atherosclerotic heart disease.All 5 critically ill patients with COVID-19 were given ventilator-assisted breathing,2 of which were given extracorporeal membrane oxygenation at the same time.According to echocardiography,the systolic pressure of pulmonary artery in 5 patients was 43-65-mmHg,with an average of 54-mmHg.The severity of pulmonary hypertension was graded as mild in 1 patient and moderate in 4 patients.During the follow-up,pulmonary artery systolic pressure gradually decreased to normal in 4 patients,and then ventilator and ECMO were withdrawn;1 patient died due to respiratory failure and persistent pulmonary hypertension.Conclusions Patients with COVID-19 may be complicated by pulmonary hypertension,which is often found in the critical patients.Echocardiography is an important imaging diagnostic method for pulmonary hypertension in patients with COVID-19.