1例病情进展迅速的重症肺炎的诊治体会

Diagnosis and treatment of rapidly progressive severe pneumonia:one case report

新冠病毒感染常态化管理后,不同病原体感染所致重症肺炎的发病率较高,由于病情进展迅速或短期难以获得病原学依据,导致部分患者较难选择有效的针对性药物。临床常给予多种抗感染药物,联合糖皮质激素抗炎、丙种球蛋白等提高免疫功能的“广覆盖治疗”及呼吸支持治疗,但死亡率较高。复旦大学附属华东医院近期收治1例基础情况好的青年非重症社区获得性肺炎(community-acquired pneumonia,CAP)患者,入院后患者病情迅速加重,十余小时后演变为重度急性呼吸窘迫综合征,且淋巴细胞下降,采用前述“广覆盖治疗”无效,经合理的生理学和生物学分析,迅速调整为以短期大剂量激素和分级无创呼吸支持为主的综合治疗,患者病情迅速好转,淋巴细胞短暂下降后迅速恢复,未出现其他明显不良反应,10日后痊愈出院。该例患者的诊治经验可为CAP的诊治提供参考。

After the standard management of COVID-19,there is a significant prevalence of severe pneumonia brought on by various pathogens.For certain patients,choosing successful targeted medications is more challenging due to the disease’s quick progression or short-term difficulty in obtaining a pathogenetic basis.The“broad coverage”treatment of giving anti-infective drugs,combined with glucocorticoids for anti-inflammation,and gamma globulin to improve immune function and respiratory support therapy is a common method,but the mortality rate is still high.A young patient with non-severe community-acquired pneumonia(CAP)was recently admitted to Huadong Hospital,Fudan University.After being admitted,the patient’s condition quickly deteriorated and developed into severe acute respiratory distress syndrome in more than 10 hours with lymphocyte decline.The aforementioned“broad coverage”treatment was ineffective for the patient.It was modified to a comprehensive treatment based on short-term high-dose glucocorticoids and graded no-invasive respiratory support after appropriate physiological and biological analysis.The patient’s condition quickly became better,and lymphocytes recovered rapidly after a transient drop.The patient did not experience any other significant adverse effects.And ten days later,she was discharged.The diagnosis and treatment experience of this patient can provide a reference for CAP diagnosis and care.