Muramatsu Ken-Ichi, Ishikawa Kouhei, Komatsu Arisa, Jitsuiki Kei, Yanagawa Youichi
Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, JPN.
Respiratory Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, JPN.
Cureus. 2021 Nov 7;13(11):e19340. doi: 10.7759/cureus.19340. eCollection 2021 Nov.
A 55-year-old man developed a low-grade fever (day 1). His wife had already been infected with COVID-19 four days previously and he had been isolated in his house as a close contact. Polymerase chain reaction for COVID-19 was positive. He had untreated diabetes mellitus. On day 7, his percutaneous saturated oxygen fell to <70% and he was transported to a hospital by ambulance. He underwent tracheal intubation, mechanical ventilation, and treatments with half steroid pulse, tocilizumab, remdesivir, and heparin. However, his ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F ratio) decreased to 120 under mechanical ventilation and he was transported to our hospital. On arrival, he did not synchronize with mechanical ventilation well. Initially, he was treated using a muscle relaxant and deep sedation to facilitate complete synchronization with mechanical ventilation and his P/F ratio improved to 247; thus, he was treated with mechanical ventilation alone with intermittent placement in the prone position. In addition, he was treated with steroid pulse therapy after steroid tapering therapy for nearly one month, glycyrrhizin, γ-globulin, azithromycin, and heparin. On day 20, the tracheal tube was removed after the improvement of the P/F ratio. We herein present the case of a patient with severe COVID-19 pneumonia who survived following treatment by intensive immune suppression therapy, including the combination of steroid pulse and tocilizumab, followed by a tapering dose of steroid therapy, after an outbreak of COVID-19 Delta variant. Further studies are needed to investigate the usefulness of this regimen.
一名55岁男性出现低热（第1天）。他的妻子4天前已感染新冠病毒，他作为密切接触者被隔离在家中。新冠病毒聚合酶链反应呈阳性。他患有未经治疗的糖尿病。第7天，他的经皮血氧饱和度降至<70%，随后被救护车送往医院。他接受了气管插管、机械通气，并接受了半量激素冲击、托珠单抗、瑞德西韦和肝素治疗。然而，他在机械通气下的动脉血氧分压与吸入氧分数比（P/F比）降至120，随后被转送至我院。入院时，他与机械通气同步性不佳。最初，使用肌肉松弛剂和深度镇静进行治疗，以促进与机械通气完全同步，其P/F比提高到247；因此，仅采用机械通气并间歇性俯卧位治疗。此外，在近1个月的激素减量治疗后，给予激素冲击治疗，同时使用甘草酸、γ-球蛋白、阿奇霉素和肝素。第20天，P/F比改善后拔除气管导管。我们在此报告一例新冠病毒德尔塔变异株爆发后，通过强化免疫抑制治疗（包括激素冲击和托珠单抗联合，随后逐渐减量激素治疗）存活的重症新冠病毒肺炎患者病例。需要进一步研究来探讨该治疗方案的有效性。
