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病例报告:皮质类固醇在新冠后肺炎管理中的潜在作用

Case Report: Potential Role of Corticosteroids in the Management of Post-COVID-19 Pneumonia.

作者信息

Aissaoui Houari, Eskenazi Anaïs, Suteau Valentin, Adenis Antoine, Drak Alsibai Kinan

机构信息

Department of Medicine, Pulmonology Unit, Cayenne Hospital Center Andrée Rosemon, Cayenne, French Guiana.

Department of Medicine, Cayenne Hospital Center Andrée Rosemon, Cayenne, French Guiana.

出版信息

Front Med (Lausanne). 2021 Sep 9;8:686806. doi: 10.3389/fmed.2021.686806. eCollection 2021.

Abstract

Certain patients who recover from severe pneumonia due to coronavirus disease 2019 (COVID-19) remain symptomatic in the post-infectious period, either clinically, radiologically, or respiratory. The post-COVID-19 period is characterized by clinical symptoms of varying duration from one subject to another and does not seem to depend on the severity of initial pneumonia. The persisting inflammatory and/or immune reactions in the post-COVID-19 period may play a role in the development of pulmonary lesions. Here, we report the case of a 61-year-old man with severe COVID-19 pneumonia, complicated by acute respiratory distress syndrome and pulmonary embolism, which required the patient's admission to the intensive care unit and high-flow oxygen therapy. The patient was hospitalized for 23 days for the management of his severe COVID-19 pneumonia. Afterwards, he was discharged home following a negative SARS-CoV-2 PCR test. The post-COVID-19 period was characterized by a complex respiratory symptomatology associating cough, resting dyspnea, and exertional dyspnea requiring oxygen therapy for several weeks. Surprisingly, the follow-up chest CT scan performed 4 weeks after discharge revealed bilateral interstitial lung lesions. After ruling out pulmonary superinfection, the patient was treated with oral corticosteroid for 3 months at a digressive dose. In our case, the use of corticosteroid therapy in the post-COVID19 phase had improved the outcome of the lung disease. These benefits are characterized by a rapid symptomatic improvement, accelerated repair of pulmonary images, rapid oxygen withdrawal, and rapid return to daily activities.

摘要

某些从2019冠状病毒病(COVID-19)导致的重症肺炎中康复的患者在感染后时期仍有症状,无论是临床症状、影像学表现还是呼吸系统症状。COVID-19后时期的特点是不同个体的临床症状持续时间各异,且似乎不取决于初始肺炎的严重程度。COVID-19后时期持续存在的炎症和/或免疫反应可能在肺部病变的发展中起作用。在此,我们报告一例61岁男性患者,患有重症COVID-19肺炎,并发急性呼吸窘迫综合征和肺栓塞,需要入住重症监护病房并接受高流量氧疗。该患者因重症COVID-19肺炎住院治疗23天。之后,在严重急性呼吸综合征冠状病毒2(SARS-CoV-2)聚合酶链反应(PCR)检测呈阴性后出院回家。COVID-19后时期的特点是出现复杂的呼吸系统症状,伴有咳嗽、静息性呼吸困难和劳力性呼吸困难,需要持续数周的氧疗。令人惊讶的是,出院后4周进行的胸部CT随访扫描显示双侧间质性肺病变。在排除肺部二重感染后,患者接受了为期3个月的递减剂量口服糖皮质激素治疗。在我们的病例中,COVID-19后阶段使用糖皮质激素治疗改善了肺部疾病的预后。这些益处表现为症状迅速改善、肺部影像修复加速、吸氧迅速撤减以及能迅速恢复日常活动。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4ff6/8458727/bb700de8fac2/fmed-08-686806-g0001.jpg

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