1例危重型新型冠状病毒肺炎患者抑制“炎症风暴”的救治体会

Treatment experience of 1 case of severe corona virus disease 2019 by inhibiting"inflammatory storm"

目的报告1例危重型新型冠状病毒肺炎(简称新冠肺炎)患者的诊治经过,探讨抑制炎症反应在治疗危重型新冠肺炎中的作用。方法华中科技大学协和江北医院收治1例危重型新冠肺炎患者,通过抑制“炎症风暴”并给予综合支持治疗后,最终救治成功,介绍临床诊治过程,分享救治体会。结果患者为53岁女性,因“发热、咳嗽4 d”考虑病毒性肺炎,于2020年1月14日入院。患者反复出现高热、胸闷、喘息,低氧血症,入院初期胸部CT可见双肺多处斑片状或大片状稍高密度影,部分呈磨玻璃样改变;新型冠状病毒(2019-nCoV)核酸检测阳性,确诊为新冠肺炎。患者入院后给予持续经鼻高流量氧疗,血氧饱和度0.80,紧急行气管插管呼吸机辅助呼吸;同时给予小剂量去甲肾上腺素(0.3μg·kg^-1·min^-1)维持血压,利巴韦林抗病毒(初始每次0.3 g、每日2次,3 d后减量为0.3 g、每日1次,4 d后停用),甲泼尼龙(40 mg、每日1次,3 d后减量为20 mg、每日1次,2 d后停用)减轻炎症反应,血必净注射液(100 mL、每日2次、连用7 d)抑制“炎症介质风暴”;同时给予护肝、抗凝、肠内营养等对症支持治疗,并行俯卧位通气16 h/d、共5 d。经治疗,患者“炎症风暴”得到控制,症状改善。1月24日患者拔除气管导管,胸部CT显示病灶逐渐吸收,于2月8日出院。结论本例患者经抑制“炎症风暴”并给予综合支持治疗后成功治愈出院,其救治经验为新冠肺炎的诊治提供参考。

Objective To report the diagnosis and treatment of 1 critical case of corona virus disease 2019(COVID-19)and to discuss the role of inhibiting inflammatory reaction in COVID-19 treatment.Methods Union Jiangbei Hospital,Huazhong University of Science and Technology admitted 1 case of severe COVID-19.By inhibiting"inflammatory storm"and comprehensive support,the final treatment was successful.This article introduced the clinical diagnosis and treatment process,and shared the experience.Results A 53-year-old female patient was admitted on January 14,2020 due to"fever and cough for 4 days"considering viral pneumonia.She had repeated high fever,chest tightness,wheezing and hypoxemia.At the early stage,the lung CT showed multiple patchy or large high-density shadows in both lungs and ground glass like changes.The patient had positive novel coronavirus(2019-nCoV)nucleic acid test and confirmed with COVID-19.After admission,the patient was given continuous high-flow nasal cannula oxygen therapy,with oxygen saturation of 0.80,and emergency intubation ventilator was used to assist respiration.Low-dose noradrenaline(0.3μg·kg^-1·min^-1)was given to maintain blood pressure.Antiviral(ribavirin 0.3 g,twice a day at first,reduced to 0.3 g,once a day,4 days later)and anti-inflammation(methylprednisolone 40 mg once daily,after 3 days 20 mg once daily,stopped after 2 days)treatment was given.Xuebijing(100 mL,twice a day,for 7 days)was given to inhibit"inflammatory mediator storm".Liver protecting,anticoagulant,enteral nutrition and other supportive treatment(ventilation in parallel prone position 16 hours per day for 5 days)was given.After treatment,the"inflammatory storm"was controled and symptoms were improved.On January 24,the tracheal tube was removed and CT showed that the focus was gradually absorbed and the patient was discharged on February 8.Conclusions This patient was cured and discharged after inhibiting"inflammatory storm"and comprehensive support treatment.The experience provides a reference for the diagnosis and treatment of COVID-19.