机械通气对危重型新型冠状病毒肺炎合并ARDS患者的救治作用

Rescue and therapeutic effect of mechanical ventilation on patients with severe coronavirus disease 2019 complicated with acute respiratory distress syndrome

目的 观察机械通气对危重型新型冠状病毒肺炎(简称新冠肺炎)合并急性呼吸窘迫综合征(ARDS)患者的救治作用.方法 分析内蒙古科技大学包头医学院第一附属医院于2020年1月30日至3月7日收治的3例危重型新冠肺炎合并ARDS患者的临床资料,记录3例患者的一般资料、临床症状、实验室检查结果和影像学表现,分析治疗经过(包括具体呼吸支持治疗方法),观察病情转归.结果 3例患者均有发热、咳嗽、咳痰、气短及乏力症状,实验室检查显示3例患者均存在白细胞计数(WBC)、淋巴细胞计数(LYM)、白蛋白及血清钠降低,C-反应蛋白(CRP)、血乳酸、乳酸脱氢酶(LDH)、D-二聚体及纤维蛋白原降解产物(FDP)升高.胸部影像学特点为双肺外带多发磨玻璃影、浸润影及实变影,累及多个肺叶.在严密观察患者意识、呼吸、氧合情况下,均给予抗病毒、糖皮质激素、人免疫球蛋白、血必净注射液、防治血栓、抗菌药物及呼吸支持治疗等.2例患者通过实施无创机械通气联合经鼻高流量湿化氧疗为主要呼吸支持手段的综合治疗后,救治成功顺利出院.1例患者因无创机械通气效果差,行经口气管插管有创机械通气治疗,同时给予镇痛镇静,拔管后给予经鼻高流量湿化氧疗,好转出院.结论 对于危重型新冠肺炎合并ARDS患者,在严密动态观察氧合、呼吸变化的基础上,将无创机械通气作为首选治疗手段,若患者氧合恶化、无创机械通气治疗效果差,则可使用有创机械通气作为治疗手段.

Objective To observe the rescue and therapeutic effect of mechanical ventilation on patients with severe coronavinus disease 2019(COVID-19)complicated with acute respiratory distress syndrome(ARDS).Methods The elinical data of 3 eritical patients of C0VID-19 complicated with ARDS admited to the First Afiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Teehnology from January 30 to March 7,2020 were analyzed.The general data,clinical sy mptorms,laboratory tests and imaging manifestations of the 3 patients were recorded,the treatment process(including specific respiratory supportive treatment)was analyzed,and the disease outcome was observed.Results In the 3 patients,there were symptoms such as fever,cough,expectoration,shortness of breath and asthenia;the laboratory examinations showed that the white blood cell count(WBC),lymphocyte count(LYM),albumin and serum sodium were dec reased,C-reactive protein(CRP).blood lactate,lactate dehydrogenase(LDH),D-dimer and fibrinogen degradation product(FDP)were inereased,and the chest imaging features were multiple ground glass,infiltrative and consolidative shadows in the outer zone of both lungs,involving multiple lobes.Under the intensive care and monitoring for consciousness,respiration and oxygenation,all patients were given antiviral,glucocorticoid,human immunoglobulin,Xuebijing injection,antithrombotic,antibacterial and respiratory support therapies,etc.for the patients.Two patients were sccessfully cured and discharged after comprehensive managements and major respiratory support method such as noninvasive mechanical ventilation combined with nasal high-1low humidifed oxygen therapy.Another patient due to poor result of non-invasive mechanical ventilation,the treatment was changed to oral endo-tracheal intubation for invasive mechanical ventilation with simultaneous using analgesia and sedation,afer extubation,th patient was given high flow humidified oxygen therapy through the nose,finally the patients'conditions were improved and discharged.Conclusions For patients with critical COVID-19 complicated with ARDS,based on strietly close dynamic observation of oxy genation and respiratory rate changes.noninvasive mechanical ventilation is the first choice of treatment.If the patients'oxygenation deteriorates or above therapeutie efet is poor,the treatment can be changed to.invasive mechanical ventilation that could be an effective therapy.