Koriyama Nobuyuki, Moriuchi Akihiro, Higashi Kensaku, Kataoka Tetsuro, Arimizu Takuro, Takaguchi Go, Matsuoka Hideki, Otsuka Maki
National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan.
Clin Med Insights Circ Respir Pulm Med. 2022 Feb 4;16:11795484211073273. doi: 10.1177/11795484211073273. eCollection 2022.
In COVID-19 pneumonia, cases of severe hypoxemia in the early stage and cases of sudden deterioration in respiratory status due to silent hypoxia leading to death, have been reported.
A 70-year-old Japanese man with essential hypertension, dyslipidemia, chronic kidney disease and emphysema was hospitalized with the novel coronavirus disease. He had hypoxemia that was disproportionate to the severity of pneumonia indicated by computed tomography (CT), along with coagulation abnormalities. We speculated that there was a high possibility that he had developed ventilation and blood flow imbalance due to pulmonary intravascular coagulopathy (PIC) or hypoxic pulmonary vasoconstriction (HPV). In this case, early, short-term combination therapy with remdesivir, nafamostat mesylate and low-dose dexamethasone (Dex) was successful.
In COVID-19 patients with multiple comorbidities who have hypoxemia and coagulation abnormalities that are disproportionate to the severity of pneumonia on CT, it is important to commence antiviral and anticoagulant therapy as soon as possible, followed by use of a low dose of Dex.
在新型冠状病毒肺炎（COVID-19肺炎）中，已有关于早期严重低氧血症病例以及因静息性低氧导致呼吸状况突然恶化而死亡的病例报道。
一名70岁的日本男性，患有原发性高血压、血脂异常、慢性肾脏病和肺气肿，因新型冠状病毒病住院。他存在与计算机断层扫描（CT）所示肺炎严重程度不相称的低氧血症，同时伴有凝血异常。我们推测他极有可能因肺血管内凝血病（PIC）或低氧性肺血管收缩（HPV）而出现通气与血流失衡。在此病例中，早期短期联合使用瑞德西韦、甲磺酸萘莫司他和低剂量地塞米松（Dex）治疗取得成功。
对于患有多种合并症、存在与CT所示肺炎严重程度不相称的低氧血症和凝血异常的COVID-19患者，尽早开始抗病毒和抗凝治疗，随后使用低剂量Dex非常重要。
