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新型冠状病毒肺炎并发气胸的临床特征:附7例分析

Clinical characteristics of coronavirus disease 2019 patients complicated with pneumothorax: analysis of 7 cases

摘要:

目的:分析新型冠状病毒肺炎(简称新冠肺炎)并发气胸患者的临床特点及预后。方法:回顾性分析黄冈市中心医院2020年1月3日至3月10日收治的7例新冠肺炎并发气胸患者的临床资料,总结临床特点和诊疗情况,分享新冠肺炎的治疗经验。结果:①一般资料:7例患者中男性5例,女性2例。其中4例无任何基础疾病,1例有糖尿病和高血压病史;1例仅有高血压病史。发生右侧气胸6例,双侧气胸1例。7例患者住院时间较长,均超过4周,且多合并多器官功能不全。②影像学检查:1例在1周内从早期演变为进展期,2周内演变为重症期,4周后并发气胸,2周内气胸吸收;其余6例入院时即表现为进展期,均在1~2周内进展为重症期,多表现为双肺弥漫性实变影、条索影及纤维化,胸膜粘连明显,病灶吸收极缓慢。③治疗:1例重型患者发病4周后并发气胸,给予无创呼吸机辅助通气治疗;其余6例危重型患者给予气管插管机械通气治疗,机械通气到发生气胸时间在3 d内的有5例,11 d后发生的有1例。④转归:未气管插管的1例患者持续给予经鼻高流量氧疗,病情平稳。6例气管插管后并发气胸患者死亡4例,另2例均在胸腔闭式引流2周内成功拔除引流管,病情逐渐稳定。结论:新冠肺炎并发气胸病情凶险且预后差,应予以足够的重视。

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abstracts:

Objective:To analyze the clinical characteristics and prognosis of coronavirus disease 2019 (COVID-19) patients complicated with pneumothorax.Methods:The clinical data of 7 COVID-19 patients complicated with pneumothorax admitted to Huanggang Central Hospital from January 3 to March 10, 2020 were retrospectively analyzed. The clinical features, diagnosis and treatment were summarized, and experience in the treatment of COVID-19 was shared.Results:① General information: among the 7 patients, 5 were males and 2 were females. Four of them had no underlying disease, and 1 had a history of diabetes and hypertension. One patient had only a history of hypertension. There were 6 cases of right pneumothorax and 1 case of bilateral pneumothorax. The 7 patients had a long hospital stay, all over 4 weeks, mostly complicated with multiple organ dysfunction. ② Imaging examination: 1 case evolved from the early stage to the advanced stage within 1 week and to the severe stage within 2 weeks. Pneumothorax occurred 4 weeks later, and was absorbed within 2 weeks. The remaining 6 patients presented progressive stage on admission, all of them advanced to severe stage within 1 to 2 weeks, and most of them presented diffused consolidation shadows, striation shadows and fibrosis of both lungs, obvious pleural adhesion, and extremely slow lesion absorption. ③ Treatment: 1 severe patient with pneumothorax 4 weeks after onset was given non-invasive mechanical ventilation. The remaining 6 critically ill patients were treated with endotracheal intubation and mechanical ventilation. Five patients were treated with mechanical ventilation within 3 days after the occurrence of pneumothorax, and 1 patient was treated with mechanical ventilation after 11 days. ④ Outcome: 1 patient without endotracheal intubation was continuously given nasal high-flow oxygen therapy, and the condition was stable. Four of the 6 patients complicated with pneumothorax after endotracheal intubation died, and the other 2 patients successfully removed the drainage tube within 2 weeks of closed thoracic drainage, and their condition gradually stabilized.Conclusion:COVID-19 complicated with pneumothorax is a dangerous disease with poor prognosis, and should be paid adequate attention.

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作者: 贾丽萍 [1] 王昌锋 [1] 张玉娇 [1] 叶媛媛 [1] 金朝霞 [2]
期刊: 《中华危重病急救医学》2020年32卷10期 1174-1177页 MEDLINEISTICPKUCSCD
栏目名称: 论著·新型冠状病毒肺炎
DOI: 10.3760/cma.j.cn121430-20200702-00640
发布时间: 2021-01-11
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