何雁飞, 连士杰, 任君琳, 董宇超. 1例新型冠状病毒肺炎的临床特点与诊疗体会[J]. 解放军医学院学报, 2020, 41(3): 220-223. DOI: 10.3969/j.issn.2095-5227.2020.03.005
引用本文: 何雁飞, 连士杰, 任君琳, 董宇超. 1例新型冠状病毒肺炎的临床特点与诊疗体会[J]. 解放军医学院学报, 2020, 41(3): 220-223. DOI: 10.3969/j.issn.2095-5227.2020.03.005
HE Yanfei, LIAN Shijie, REN Junlin, DONG Yuchao. Clinical characteristics, diagnosis and treatment of COVID-19: A case report[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2020, 41(3): 220-223. DOI: 10.3969/j.issn.2095-5227.2020.03.005
Citation: HE Yanfei, LIAN Shijie, REN Junlin, DONG Yuchao. Clinical characteristics, diagnosis and treatment of COVID-19: A case report[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2020, 41(3): 220-223. DOI: 10.3969/j.issn.2095-5227.2020.03.005

1例新型冠状病毒肺炎的临床特点与诊疗体会

Clinical characteristics, diagnosis and treatment of COVID-19: A case report

  • 摘要:
      目的  探讨1例新型冠状病毒肺炎患者的临床特点及诊疗体会,为临床诊治提供参考。
      方法  在武汉火神山医院收治的新型冠状病毒肺炎患者中,选取1例较具代表性且成功治愈出院的患者,对其临床特点进行分析,总结临床诊疗体会。
      结果  患者男性,42岁,武汉市医务工作者,起病前多次接触发热患者。临床症状以干咳、乏力和发热为主,发热稍晚于干咳、乏力出现。1月22日入住汉口医院,入院当天查外周血白细胞总数正常,淋巴细胞计数减少,超敏C反应蛋白升高,降钙素原正常。咽拭子2019-nCoV病毒核酸检测阳性。胸部CT早期有单发和双肺多发磨玻璃影,病变以肺外周、胸膜下分布为主。入院第4天病情逐渐加重,呼吸频率加快,体温升高,外周血淋巴细胞进行性减少。入院第8天体温最高40.7℃,高流量吸氧状态下氧饱和度(SpO2)83%。胸部CT表现进展迅速,病灶数目明显增多,范围明显扩大,密度增高,病灶分布由外周向中央推进。予空气隔离、鼻导管吸氧及对症支持等治疗的同时,全程使用抗病毒药物:1月22日予磷酸奥司他韦胶囊75 mg,口服,2次/d,服用6 d; 1月24日增加克力芝治疗3片,口服,2次/d,服用6 d; 后改为阿比多尔治疗,0.2 g(2片),口服,3次/d,服用5 d。重症期予甲泼尼龙针40 mg+0.9%氯化钠注射液10 ml静脉推注,1次/12 h; 人免疫球蛋白20 g,静脉滴注,1次/d; 胸腺法新(日达仙),1.6 mg,皮下注射,1次/d免疫联合治疗。2月2日患者症状缓解,各项指标好转,肺部炎症明显吸收,2月4日及2月9日复查咽拭子均显示2019-nCoV核酸阴性,住院19 d后治愈出院。
      结论  青壮年新型冠状病毒肺炎经积极治疗,可临床治愈。

     

    Abstract:
      Objective  To explore the clinical characteristics, diagnosis and treatment of Coronavirus Disease 2019 (COVID-19), and provide evidence for its clinical diagnosis and treatment.
      Methods  The patient was a 42 year-old male with COVID-19, who was admitted to Hankou Hospital on January 22, 2020. On February 4, he was transferred to Huoshenshan Hospital, and then was successfully cured and discharged on February 9. The clinical characteristics of the patient was analyzed, and the clinical diagnosis and treatment experience was summarized.
      Results  The patient was a medical worker in Wuhan who had been exposed to fever patients many times before the onset of the disease. The main clinical symptoms were dry cough, fatigue and fever, with fever appearing later than dry cough and fatigue. On the day of admission, the total number of leukocytes in peripheral blood was normal, lymphocyte count decreased, the hypersensitive c-reactive protein (hsCRP) increased, and the procalcitonin was normal. Throat swab tested positive for nucleic acid of 2019-nCoV virus. In the early stage, the chest CT showed that there were multiple ground glass shadows in bilateral lungs, the pathological changes were mainly distributed subpleurally and perpherally. From the 4th day of admission, the patient's condition gradually worsened, with increased respiratory rate and body temperature, and the peripheral blood lymphocyte decreased progressively. On the 8th day of admission, the patient's highest temperature was 40.7℃, and the oxygen saturation (SpO2) was 83% under the condition of high flow oxygen inhalation. The chest CT findings showed that the virus progressed rapidly, the number of lesions increased significantly with expanded scope and increased density. The distribution of lesions advanced from peripheral to central. In addition to the treatment of air isolation, nasal catheter oxygen inhalation and symptomatic support, antiviral drugs were used throughout the treatment. On January 22, oseltamivir phosphate capsule was given orally (75 mg, 2 times per day) for 6 days; On January 24, 3 tablets of Lopinavir and Ritonavir Tablets were administered orally (2 times per day) for 6 days; Then, Arbidol Tablet, 0.2 g (2 tablets) were administered orally (3 times per day) for 5 days. In severe stage, methylprednisolone was given (40 mg) once per 12 h, intravenous infusion of immunoglobulin (20g) once per day, and subcutaneous injection of Thymosin (1.6 mg) once per day. On February 2, the symptoms were relieved, various indicators were improved, and the pulmonary lesion was obviously absorbed. The results of throat swab on February 4th and 9th were negative for 2019-nCoV nucleic acid test. After 19 days' hospitalization, the patient was cured and discharged.
      Conclusion  The COVID-19 in young adults can be cured by active treatment.

     

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