Liu Yan, Wang Meifang, Luo Guoshi, Qian Xin, Wu Chenglin, Zhang Yizhong, Chen Biyu, Leung Elaine Lai-Han, Tang Yijun
Department of Respiratory and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan.
State Key Laboratory of Quality Research in Chinese Medicine/Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau (SAR), China.
Medicine (Baltimore). 2020 Oct 16;99(42):e22577. doi: 10.1097/MD.0000000000022577.
The new coronavirus pneumonia Corona Virus Disease 2019 (COVID-19) has become a global pandemic. Patients with critically COVID-19 usually require invasive respiratory support, and the airway management is particularly important and the prognosis is poor.
A 64-year-old man with an anastomotic fistula after radical treatment of esophageal cancer and right-side encapsulated pyopneumothorax was admitted with cough and dyspnea.
The patient was diagnosed with novel coronavirus pneumonia and right-side encapsulated pyopneumothorax by pharyngeal swab nucleic acid test in combination with chest computed tomography (CT).
The patient was treated with antibiotics, antiviral and antibacterial medications, respiratory support, expectorant nebulization, and nutritional support. But he expressed progressive deterioration. Endotracheal intubation and mechanical ventilation were performed since the onset of the type - respiratory failure on the 13th day of admission. The patient had persistent refractory hypercapnia after mechanical ventilation. Based on the treatment mentioned above, combined with repeated bronchoalveolar lavage by using N-acetylcysteine (NAC) inhalation solution, the patients refractory hypercapnia was gradually improved.
The patient was cured and discharged after being given the mechanical ventilation for 26 days as well as 46 days of hospitalization, currently is surviving well.
Patients with severe conditions of novel coronavirus pneumonia often encounter bacterial infection in their later illness-stages. They may suffer respiratory failure and refractory hypercapnia that is difficult to improve due to excessive mucus secretion leading to small airway obstruction. This study provided a new insight on the proper treatment severe COVID-19 patients. The use of reasonable antibiotics and symptomatic respiratory support and other treatment, timely artificial airway and repeated bronchoalveolar NAC inhalation solution lavage, expectorant and other airway management are essential for such patients.
新型冠状病毒肺炎（Corona Virus Disease 2019，COVID-19）已成为全球大流行疾病。重症COVID-19患者通常需要有创呼吸支持，气道管理尤为重要且预后较差。
一名64岁男性，食管癌根治术后出现吻合口瘘并右侧包裹性脓气胸，因咳嗽、呼吸困难入院。
通过咽拭子核酸检测结合胸部计算机断层扫描（CT），该患者被诊断为新型冠状病毒肺炎和右侧包裹性脓气胸。
患者接受了抗生素、抗病毒和抗菌药物治疗、呼吸支持、祛痰雾化及营养支持。但病情逐渐恶化。入院第13天出现Ⅰ型呼吸衰竭后行气管插管及机械通气。机械通气后患者持续存在难治性高碳酸血症。在上述治疗基础上，联合使用N-乙酰半胱氨酸（NAC）吸入溶液反复进行支气管肺泡灌洗，患者的难治性高碳酸血症逐渐改善。
患者机械通气26天及住院46天后治愈出院，目前生存良好。
新型冠状病毒肺炎重症患者在病程后期常并发细菌感染。他们可能因黏液分泌过多导致小气道阻塞而出现呼吸衰竭和难以改善的难治性高碳酸血症。本研究为重症COVID-19患者的恰当治疗提供了新的见解。对于此类患者，合理使用抗生素及对症呼吸支持等治疗，及时建立人工气道并反复使用NAC吸入溶液进行支气管肺泡灌洗、祛痰等气道管理至关重要。
