COVID-19危重症患者机械通气后并发气胸的特征分析及治疗

Analysis and treatment of pneumothorax after mechanical ventilation in critical patients with COVID-19

目的分析新型冠状病毒肺炎(COVID-19)危重症患者临床特征及机械通气后并发气胸情况,指导抗疫防治工作。方法回顾性分析武汉市金银潭医院重症病区2020年1月1日至2020年2月13日收治的COVID-19危重症患者130例。分析其临床特征、机械通气相关气胸及治疗情况。结果130例COVID-19危重症患者中,出现机械通气相关性气胸(包括双侧和单侧气胸)7例,占比5.38%,7例气胸患者均行床旁闭式引流术治疗,胸腔闭式引流后氧饱和度和氧分压均有明显改善。其他指标(酸碱度、乳酸值、二氧化碳分压、氧合指数)差异无统计学意义。结论对于大型的COVID-19危重症治疗中心,建议有胸外科医师参与,以应对机械通气后相关胸外科并发症。气胸发生后无其他明显禁忌的情况下,应及时行胸腔闭式引流治疗。

Objective The clinical characteristics of critical COVID-19 patients with pneumothorax after mechanical ventilation were retrospectively analyzed to provide reference for epidemic prevention and treatment.Methods A retrospective analysis was made on 130 cases of COVID-19 critically patients admitted from January 1,2020 to February 13,2020 in Jinyintan Hospital of Wuhan.The clinical characteristics,mechanical ventilation related pneumothorax and treatment were analyzed.Results Among the 130 patients with COVID-19 in critical condition,7(5.38%)cases had mechanical ventilation related pneumothorax(including bilateral and unilateral pneumothorax).All the 7 pneumothorax patients received bedside closed drainage,oxygen saturation and oxygen partial pressure were significantly improved after closed thoracic drainage.No statistical differences were found in other indexes(pH,lactic acid,PCO2,oxygenation index).Conclusion For large critical COVID-19 care centers,the involvement of thoracic surgeons are recommended to deal with the thoracic complications associated with mechanical ventilation.After the occurrence of pneumothorax,if there are no other obvious contrainstances,thoracic closed drainage should be given in time.