高压氧治疗老年危重型新型冠状病毒肺炎气管插管患者1例临床效果

目的 报道1例高龄危重型新型冠状病毒肺炎（COVID-19）气管插管患者的高压氧治疗（HBOT）经验，为拓展HBOT在COVID-19治疗中的应用提供参考依据。方法和结果 患者男，87岁，2020年2月3日出现昏迷症状，行胸部CT检查示双肺多发小片状模糊影，2月5日肺泡灌洗液严重急性呼吸综合征冠状病毒2（SARS-CoV-2）核酸检测阳性，确诊COVID-19。经对症、支持治疗后患者病情逐渐稳定，于2月22日拔除气管插管，但因患者无咳嗽、排痰能力于2月24日再次气管插管、呼吸机辅助呼吸，判断病情为危重型。2月29日患者首次接受HBOT，医护人员经专用通道进入高压氧舱全程陪同。HBOT治疗4次后，患者动脉血氧分压（PaO₂）与动脉血二氧化碳分压（PaCO₂）趋向稳定，CO₂潴留现象缓解，肝肾功能有所改善，凝血功能恢复，3月6日查SARS-CoV-2 IgM阴性、SARS-CoV-2 IgG阳性，转入普通病房继续治疗。结论 HBOT有利于缓解危重型COVID-19患者的CO₂潴留现象，对降低机体缺氧损伤、保护重要脏器功能有积极作用。整体HBOT感染控制程序可行，通过合理设计能够保障医务人员安全。

Hyperbaric oxygen therapy in an elderly critical coronavirus disease 2019 patient with endotracheal intubation: clinical effect analysis

Objective To sum up our experience of hyperbaric oxygen therapy (HBOT) in an elderly critical coronavirus disease 2019 (COVID-19) patient with endotracheal intubation, providing references for the application of HBOT in COVID-19 treatment. Methods and results The patient was 87 years old male and presented coma symptoms on Feb. 3, 2020. Chest computed tomography (CT) showed multiple small flake fuzzy shadows in both lungs. The nucleic acid test of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in bronchoalveolar lavage fluid was positive on Feb.5 and the diagnosis of COVID-19 was confirmed. After symptomatic and supportive treatment, the patient''s condition became stable gradually, and the tracheal intubation was removed on Feb. 22. However, the patient was intubated again on Feb. 24 because of loss of coughing and sputum expelling abilities, and the patient''s condition was judged to be critical. On Feb. 29, the patient received HBOT for the first time, and medical staff entered the hyperbaric oxygen cabin through the special channel. After HBOT for four times, arterial partial pressure of oxygen (PaO₂) and arterial partial pressure of carbon dioxide (PaCO₂) of the patient tended to be stable, carbon dioxide retention was alleviated, liver and kidney function improved, and coagulation function recovered. On Mar. 6, SARS-CoV-2 immunoglobulin (Ig) test showed that SARS-CoV-2 IgM was negative and SARS-CoV-2 IgG was positive. The patient was then transferred to general wards. Conclusion HBOT can alleviate CO₂ retention in critical COVID-19 patients, and has a positive effect on reducing hypoxia and protecting important organs. The HBOT infection control procedure is feasible, and the safety of medical staff can be guaranteed by reasonable design.