Zeng Jia, Qi Xiao-Xia, Cai Wan-Wan, Pan Ya-Ping, Xie Yi
Department of Aviation Disease, Naval Medical Center of PLA, Shanghai 200052, China.
Department of Traditional Chinese Medicine, Naval Medical Center of PLA, Shanghai 200052, China.
World J Clin Cases. 2021 Nov 6;9(31):9481-9490. doi: 10.12998/wjcc.v9.i31.9481.
The novel coronavirus disease 2019 (COVID-19) has spread widely around the world with strong infectivity, rapid mutation and a high mortality rate. Mechanical ventilation has been included in the () as an important treatment for severe and critical COVID-19 patients, but its clinical efficacy in COVID-19 patients is various. Therefore, it is necessary to study the influencing factors on the efficacy of mechanical ventilation in severe and critical COVID-19 patients.
The aim of this study was to determine the influencing factors on the efficacy of mechanical ventilation in severe and critical COVID-19 patients.
A total of 27 severe and critical COVID-19 patients were enrolled in this study and treated with mechanical ventilation at the Optical Valley Campus of Hubei Maternal and Child Health Care Hospital (Wuhan, Hubei Province) from February 20, 2020 to April 5, 2020. According to the final treatment outcomes, the patients were divided into the "effective group" and "death group." The clinical data of the two groups, such as the treatment process and final outcome, were retrospectively analyzed in order to determine the specific curative effects on the two groups and the reasons for the differences in such curative effects, as well as to explore the factors related to death.
This study enrolled 27 severe and critical COVID-19 patients, including 17 males (63.0%) and 10 females (37.0%). Their ages were 74.41 ± 11.73-years-old, and 19 patients (70.4%) were over 70-years-old. Severe COVID-19 patients over 70-years-old who were treated with mechanical ventilation died in 14 cases (82.4%); thus, this was the peak age. A total of 17 patients died of basic disease, 16 of whom had more than two basic diseases. The basic diseases were hypertension, diabetes, and cardiovascular and cerebrovascular diseases. At the same time, 13 patients (76.5%) died from an abnormal increase in blood glucose. Among them, eight had diabetes before contracting COVID-19 and five had a stress-induced increase in blood glucose after contracting COVID-19. Diabetic ketoacidosis occurred in one case. The use of tocilizumab may be a double-edged sword that carries a certain risk in clinical usage. Among the patients who died, 16 (94.1%) went into septic shock at the end. There were significant differences in the degree of infection, cardiac and renal function, and blood glucose between the death group and effective group.
Age, blood glucose, cardiac and renal function, and inflammatory reaction are important indicators of poor prognosis for mechanical ventilation in severe and critical COVID-19 patients.
新型冠状病毒肺炎（COVID-19）在全球广泛传播，具有强传染性、快速变异和高死亡率。机械通气已被纳入[具体内容缺失]作为重症和危重症COVID-19患者的重要治疗手段，但其在COVID-19患者中的临床疗效各异。因此，有必要研究影响重症和危重症COVID-19患者机械通气疗效的因素。
本研究旨在确定影响重症和危重症COVID-19患者机械通气疗效的因素。
本研究共纳入27例重症和危重症COVID-19患者，于2020年2月20日至2020年4月5日在湖北省妇幼保健院光谷院区（湖北省武汉市）接受机械通气治疗。根据最终治疗结果，将患者分为“有效组”和“死亡组”。对两组患者的临床资料，如治疗过程和最终结局进行回顾性分析，以确定对两组的具体疗效以及疗效差异的原因，并探讨与死亡相关的因素。
本研究纳入27例重症和危重症COVID-19患者，其中男性17例（63.0%），女性10例（37.0%）。年龄为74.41±11.73岁，19例患者（70.4%）年龄超过70岁。70岁以上接受机械通气治疗的重症COVID-19患者死亡14例（82.4%）；因此，这是发病高峰年龄。共有17例患者死于基础疾病，其中16例患有两种以上基础疾病。基础疾病为高血压、糖尿病以及心脑血管疾病。同时，13例患者（76.5%）死于血糖异常升高。其中，8例在感染COVID-19前患有糖尿病，5例在感染COVID-19后应激性血糖升高。1例发生糖尿病酮症酸中毒。使用托珠单抗可能是一把双刃剑，在临床使用中存在一定风险。在死亡患者中，16例（94.1%）最终发生感染性休克。死亡组与有效组在感染程度、心肾功能及血糖方面存在显著差异。
年龄、血糖、心肾功能及炎症反应是重症和危重症COVID-19患者机械通气预后不良的重要指标。
