中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2015年
10期
841-844
,共4页
罗裕锋%瞿嵘%凌云%覃铁和
囉裕鋒%瞿嶸%凌雲%覃鐵和
라유봉%구영%릉운%담철화
中东呼吸综合征%急性呼吸窘迫综合征%经鼻高流量氧疗
中東呼吸綜閤徵%急性呼吸窘迫綜閤徵%經鼻高流量氧療
중동호흡종합정%급성호흡군박종합정%경비고류량양료
Middle East respiratory syndrome%Acute respiratory distress syndrome%High-flow nasal cannula
目的：探讨经鼻高流量氧疗（HFNC）治疗中东呼吸综合征（MERS）患者的应用价值。方法2015年5月28日广东省惠州市中心人民医院重症医学科收治中国首例输入性MERS并急性呼吸窘迫综合征（ARDS）患者，通过观察应用HFNC的临床疗效，分析各项临床参数的变化及意义。结果患者男性，43岁，因背部酸痛7 d、发热2 d入院。患者入院后住负压隔离监护病房，持续监测生命体征和脉搏血氧饱和度（SpO2）等。入院后给予口服利巴韦林共12 d；入院第1天曾应用α-干扰素1次；但抗病毒治疗2周后病毒相关检测仍为阳性。入院第4天予头孢曲松钠治疗，3 d后改为美罗培南治疗，2周后停用；入院第4天开始应用免疫球蛋白1周，入院第8天开始应用胸腺肽α1共2周。根据既往史，继续使用甲巯咪唑治疗甲状腺功能亢进（甲亢）；同时给予其他对症支持治疗等。入院后即予鼻导管氧疗（6 L/min），但患者病情逐渐加重，频繁咳嗽，伴有明显气促，X线胸片示肺部渗出逐渐增加。SpO2仅可维持在0.91左右，氧合指数（PaO2/FiO2）降至144 mmHg（1 mmHg＝0.133 kPa）。遂于鼻导管氧疗2 d后改用HFNC，参数设定为：温度34℃，流量20 L/min，吸入氧浓度（FiO2）0.50，每10 min上调流量5 L/min，重复操作直至目标值60 L/min；根据SpO2、PaO2/FiO2等调整FiO2，入院第5天FiO2调整至0.80。经积极应用HFNC后，入院第7天患者气促症状好转，PaO2/FiO2上升，逐渐调低FiO2至0.58；随后流量缓慢下调至30 L/min。PaO2/FiO2持续改善，继续降低HFNC参数，于入院第20天停用HFNC，改为鼻导管低流量氧疗（2～3 L/min）。入院第23天停用氧疗，SpO2维持在0.98～1.00，床旁活动量逐渐增加。6月26日患者治愈出院。患者应用HFNC的耐受性好、依从性高；治疗期间未发生院内传播。结论 HFNC可明显改善MERS患者的呼吸功能并纠正伴发的ARDS，或能减少院内传播。
目的：探討經鼻高流量氧療（HFNC）治療中東呼吸綜閤徵（MERS）患者的應用價值。方法2015年5月28日廣東省惠州市中心人民醫院重癥醫學科收治中國首例輸入性MERS併急性呼吸窘迫綜閤徵（ARDS）患者，通過觀察應用HFNC的臨床療效，分析各項臨床參數的變化及意義。結果患者男性，43歲，因揹部痠痛7 d、髮熱2 d入院。患者入院後住負壓隔離鑑護病房，持續鑑測生命體徵和脈搏血氧飽和度（SpO2）等。入院後給予口服利巴韋林共12 d；入院第1天曾應用α-榦擾素1次；但抗病毒治療2週後病毒相關檢測仍為暘性。入院第4天予頭孢麯鬆鈉治療，3 d後改為美囉培南治療，2週後停用；入院第4天開始應用免疫毬蛋白1週，入院第8天開始應用胸腺肽α1共2週。根據既往史，繼續使用甲巰咪唑治療甲狀腺功能亢進（甲亢）；同時給予其他對癥支持治療等。入院後即予鼻導管氧療（6 L/min），但患者病情逐漸加重，頻繁咳嗽，伴有明顯氣促，X線胸片示肺部滲齣逐漸增加。SpO2僅可維持在0.91左右，氧閤指數（PaO2/FiO2）降至144 mmHg（1 mmHg＝0.133 kPa）。遂于鼻導管氧療2 d後改用HFNC，參數設定為：溫度34℃，流量20 L/min，吸入氧濃度（FiO2）0.50，每10 min上調流量5 L/min，重複操作直至目標值60 L/min；根據SpO2、PaO2/FiO2等調整FiO2，入院第5天FiO2調整至0.80。經積極應用HFNC後，入院第7天患者氣促癥狀好轉，PaO2/FiO2上升，逐漸調低FiO2至0.58；隨後流量緩慢下調至30 L/min。PaO2/FiO2持續改善，繼續降低HFNC參數，于入院第20天停用HFNC，改為鼻導管低流量氧療（2～3 L/min）。入院第23天停用氧療，SpO2維持在0.98～1.00，床徬活動量逐漸增加。6月26日患者治愈齣院。患者應用HFNC的耐受性好、依從性高；治療期間未髮生院內傳播。結論 HFNC可明顯改善MERS患者的呼吸功能併糾正伴髮的ARDS，或能減少院內傳播。
목적：탐토경비고류량양료（HFNC）치료중동호흡종합정（MERS）환자적응용개치。방법2015년5월28일광동성혜주시중심인민의원중증의학과수치중국수례수입성MERS병급성호흡군박종합정（ARDS）환자，통과관찰응용HFNC적림상료효，분석각항림상삼수적변화급의의。결과환자남성，43세，인배부산통7 d、발열2 d입원。환자입원후주부압격리감호병방，지속감측생명체정화맥박혈양포화도（SpO2）등。입원후급여구복리파위림공12 d；입원제1천증응용α-간우소1차；단항병독치료2주후병독상관검측잉위양성。입원제4천여두포곡송납치료，3 d후개위미라배남치료，2주후정용；입원제4천개시응용면역구단백1주，입원제8천개시응용흉선태α1공2주。근거기왕사，계속사용갑구미서치료갑상선공능항진（갑항）；동시급여기타대증지지치료등。입원후즉여비도관양료（6 L/min），단환자병정축점가중，빈번해수，반유명현기촉，X선흉편시폐부삼출축점증가。SpO2부가유지재0.91좌우，양합지수（PaO2/FiO2）강지144 mmHg（1 mmHg＝0.133 kPa）。수우비도관양료2 d후개용HFNC，삼수설정위：온도34℃，류량20 L/min，흡입양농도（FiO2）0.50，매10 min상조류량5 L/min，중복조작직지목표치60 L/min；근거SpO2、PaO2/FiO2등조정FiO2，입원제5천FiO2조정지0.80。경적겁응용HFNC후，입원제7천환자기촉증상호전，PaO2/FiO2상승，축점조저FiO2지0.58；수후류량완만하조지30 L/min。PaO2/FiO2지속개선，계속강저HFNC삼수，우입원제20천정용HFNC，개위비도관저류량양료（2～3 L/min）。입원제23천정용양료，SpO2유지재0.98～1.00，상방활동량축점증가。6월26일환자치유출원。환자응용HFNC적내수성호、의종성고；치료기간미발생원내전파。결론 HFNC가명현개선MERS환자적호흡공능병규정반발적ARDS，혹능감소원내전파。
ObjectiveTo investigate the value of high flow nasal cannula (HFNC) in treating a patient with Middle East respiratory syndrome (MERS).Methods The effect of HFNC applied in the first imported MERS patient with complication of acute respiratory distress syndrome (ARDS) to China was observed. The patient was admitted to Department of Critical Care Medicine of Huizhou Municipal Central Hospital on May 28th, 2015, and the changes in various clinical parameters and their significance were analyzed.Results A 43-year old male was admitted to negative pressure isolation intensive care unit with the complaint of back ache for 7 days and fever for 2 days. Vital signs and saturation of pulse oximetry (SpO2) were monitored continuously. After admission, ribavirin was given orally for 12 days andα-interferon was administered once on the first day. However, after 2-week anti-virus therapy, the virus test was positive. Ceftriaxone was given on the 4th day, and it was changed to meropenem on the 3rd day for 2 weeks. Immune globulin was given on the 4th day and continued for 1 week. Thymosin-α1 was given on the 8th day and continued for 2 weeks. According to his past history, methimazole had been given continuously for hyperthyroidism and other symptomatic treatment. Oxygen inhalation (6 L/min) was given immediately after admission, but the condition of patient worsened with the following symptoms: frequent cough and obvious shortness of breath. Moreover pleural effusion gradually increased as shown by X-ray. SpO2 was maintained only at about 0.91. Oxygenation index (PaO2/FiO2) decreased to 144 mmHg (1 mmHg = 0.133 kPa). So oxygen inhalation via nasal cannula was changed to HFNC after 2 days. The parameters were set as follows: temperature 34℃, flow rate 20 L/min, fraction of inspired oxygen (FiO2) 0.50. The flow was raised 5 L/min every 10 minutes, and was continued till the target value reached 60 L/min. FiO2 was modified according to SpO2 and PaO2/FiO2. FiO2 was set to 0.80 on the 5th day of admission. Shortness of breath of the patient was improved on the 7th day of admission after the application of HFNC. FiO2 was then decreased to 0.58 as PaO2/FiO2 rose. Then the flow was gradually decreased to 30 L/min. HFNC was reduced with continuous improvement in PaO2/FiO2. HFNC was changed to low flow oxygen inhalation nasal cannula (2-3 L/min) on the 20th day. Oxygen treatment was stopped on the 23rd day, and SpO2 was maintained at 0.98-1.00. Activities on bed were gradually increased. The patient was cured and discharged from hospital on June 26th. The patient showed good tolerance and high compliance during the treatment with HFNC. No nosocomial spread occurred during the treatment.ConclusionsHFNC could improve respiratory function of the patient with MERS obviously, and complication ARDS was prevented. HFNC might reduce nosocomial spread.
