摘要
H10N3禽流感是一种禽流感病毒,偶见传染人类,可导致重症肺炎及急性呼吸窘迫综合征(ARDS)。2024年12月25日南宁市第四人民医院收治1例23岁女性H10N3禽流感并发重度ARDS的肥胖患者。患者因"发热、咳嗽伴气促13 d"从外院转入本院重症医学科。查体示双肺湿性啰音;胸部影像学检查显示双肺大片磨玻璃样变和实变。结合患者病史、临床表现、实验室检查结果,诊断为人感染H10N3禽流感、重症肺炎、重度ARDS。予机械通气+体外膜肺氧合(ECMO)支持,每日监测气道峰压、平台压(Pplat)、驱动压(ΔP)和肺顺应性,应用以上指标指导有创机械通气期间潮气量(VT)、呼气末正压(PEEP)参数调节,药物上予抗禽流感病毒、抗细菌、抗真菌等治疗,患者病情逐渐好转,成功撤离ECMO。ECMO支持过程中未出现呼吸机相关性肺损伤(VILI)及ARDS相关多器官功能障碍综合征(MODS)。但在恢复自主呼吸后准备撤离呼吸机环节,患者出现右侧气胸,行胸腔闭式引流后成功撤离呼吸机。最终患者顺利转出重症监护病房(ICU),康复出院。H10N3禽流感合并ARDS患者有创机械通气治疗过程中,监测气道峰压、Pplat和ΔP,评估肺顺应性等,可能可以更规范化管理该类ARDS患者,减少VILI。
Avian influenza H10N3 is a type of avian influenza virus that can occasionally infect humans and cause severe pneumonia and acute respiratory distress syndrome(ARDS).On December 25,2024,a 23-year-old obese female patient with H10N3 avian influenza complicated with severe ARDS was admitted to the Fourth People's Hospital of Nanning.The patient was transferred to our department due to"fever,cough,and shortness of breath for 13 days".Physical examination revealed moist rales in bilateral lungs.Chest imaging showed large areas of ground-glass opacity and consolidation in both lungs.Based on the patient's medical history,clinical manifestations,and laboratory findings,she was diagnosed with human infection of H10N3 avian influenza,severe pneumonia,and severe ARDS.Supported by mechanical ventilation and extracorporeal membrane oxygenation(ECMO),daily monitoring of airway peak pressure,plateau pressure(Pplat),driving pressure(ΔP),and lung compliance was performed to guide the adjustment of tidal volume(VT)and positive end-expiratory pressure(PEEP)during invasive mechanical ventilation.Medications including anti-avian influenza virus agents,antibacterial drugs,and antifungals were administered.Eventually,the patient's condition improved gradually,and she was successfully weaned from ECMO.No ventilator-induced lung injury(VILI)or multiple organ dysfunction syndrome(MODS)related to ARDS occurred during ECMO support.However,during the final stage of ventilator weaning after the restoration of spontaneous breathing,a right pneumothorax occurred.Closed thoracic drainage was performed,after which the ventilator was successfully discontinued.The patient was successfully transferred out of the intensive care unit(ICU),recovered fully,and was discharged from the hospital.In the invasive mechanical ventilation management of patients infected with H10N3 avian influenza complicated by ARDS,monitoring airway peak pressure,Pplat,ΔP,and assessing pulmonary compliance may facilitate more standardized management of such ARDS patients and help reduce VILI.
作者
李幼玲
谢周华
岑平
刘升
陆宁
谭仕稷
卢宇明
韦静
Li Youling;Xie Zhouhua;Cen Ping;Liu Sheng;Lu Ning;Tan Shiji;Lu Yuming;Wei Jing(Department of Critical Care Medicine,the Fourth People's Hospital of Nanning,Nanning 530013,China)
出处
《中华危重病急救医学》
北大核心
2025年第9期871-874,共4页
Chinese Critical Care Medicine
关键词
H10N3禽流感
急性呼吸窘迫综合征
小潮气量
最佳呼气末正压
肺顺应性
H10N3 avian influenza
Acute respiratory distress syndrome
Small tidal volume
Optimal positive end-expiratory pressure
Lung compliance
