CAJ | 학술논문

目的总结重症高致病性禽流感A/H5N1病毒感染(简称人禽流感)患者的临床特点、治疗经验以及合并支气管胸膜瘘的处理方法.方法对2007年2月福建省建瓯市立医院成功救治的1例重症人禽流感并发右侧支气管胸膜瘘患者的临床资料和诊治过程进行回顾性分析.结果患者女,44岁,发病前3 d有病死鸡接触史,以发热、气促为主要症状,经呼吸道分泌物检测A/H5N1病毒核酸阳性确诊.患者住院第7天发展为急性呼吸窘迫综合征,病情重、进展快,病程中出现呼吸机相关肺炎、双侧气胸、右侧支气管胸膜瘘等多种并发症.经奥司他韦抗病毒、糖皮质激素抗炎、输注康复期血浆、机械通气、抗感染等治疗,病情有所缓解,但支气管胸膜瘘持续存在并形成脓胸,导致脱机困难.经纤维支气管镜下气囊探查加选择性支气管封堵术、经纤维支气管镜右侧支气管胸膜瘘OB胶粘堵术等介入治疗,患者痊愈,发病第99天出院.结论人禽流感并发难治性支气管胸膜瘘患者在采取抗病毒、抗感染、机械通气支持、输注康复期血浆等综合治疗的基础上结合介入治疗是可行的.
목적 총결중증고치병성금류감A/H5N1병독감염(간칭인금류감)환자적림상특점、치료경험이급합병지기관흉막루적처리방법.방법 대2007년2월복건성건구시립의원성공구치적1례중증인금류감병발우측지기관흉막루환자적림상자료화진치과정진행회고성분석.결과 환자녀,44세,발병전3 d유병사계접촉사,이발열、기촉위주요증상,경호흡도분비물검측A/H5N1병독핵산양성학진.환자주원제7천발전위급성호흡군박종합정,병정중、진전쾌,병정중출현호흡궤상관폐염、쌍측기흉、우측지기관흉막루등다충병발증.경오사타위항병독、당피질격소항염、수주강복기혈장、궤계통기、항감염등치료,병정유소완해,단지기관흉막루지속존재병형성농흉,도치탈궤곤난.경섬유지기관경하기낭탐사가선택성지기관봉도술、경섬유지기관경우측지기관흉막루OB효점도술등개입치료,환자전유,발병제99천출원.결론 인금류감병발난치성지기관흉막루환자재채취항병독、항감염、궤계통기지지、수주강복기혈장등종합치료적기출상결합개입치료시가행적.
Objective To summarize the clinical charactaristics and therapeutic experience of A/ H5N1 infected patient with intractable bronchopleural fistula.Method The data of a patient with A/H5N1 infection complicated with bronchopleural fistula was collected and analyzed.Results A 44-year-old woman with pneuminian was diagnosed as A/H5N1 infection by reverse-transcription polymerase chain reaction(RT-PCR) in laboratory from the sample of secretion of respiratory tracts.She had exposed to sick or dead poultry 3 days before development of illness.She developed acute respiratory distress syndrome 7 days after onset of sickness.After comprehensive management with antiviral agents,antibiotics,convalescent serum and invasive ventilation,her clinical condition improved and turned to stable.However,16 days after onset of illness,her clinical situation deteriorated due to ventilator-associated pneumonia,bilateral pneumothorax and persistent right bronchopleural fistula.After partly failure of beside assist thoracoscopy to fix the pleura/ fistula,transbronchocopic bronchial occlusion by autoblood was explored and the air leakage stopped soon after occlusion.Three days after the autoblood clot was expectorated out and air leak recurred.Then,bronchopleural fistula on the surface of visceral pleura was successfully blocked by biogel and OB gel through pleural cavity by fibrobronchoscopy.The patient was discharged from the hospital 99 days after onset of illness (at the 94<'t,h> hospital day).Conclusion Bronchopleural fistula was an intractable complication for patient with A/H5N1 infection.Occlusion operation by biogel and OB gel through bronchoscopy might be an alternative choice for fixing the bronchopleural fistula.