贵州省首例重症人感染高致病性H5N1亚型禽流感致急性呼吸窘迫综合征患者的机械通气策略探讨

目的 探讨重症高致病性H5N1人禽流感病例急性呼吸窘迫综合征(ARDS)机械通气策略.方法 对2009年1月15日本院收治的1例重症高致病性H5N1亚型禽流感感染患者的资料进行分析、总结.结果 患者男性,29岁,发病前有家禽宰杀史,以畏寒、发热起病,持续高热,继之出现进行性呼吸困难.1月19日(发病5 d)胸部影像学可见以左下肺为主的双肺炎症表现,迅速进展出现ARDS样肺部表现.立即给予机械通气为主的综合治疗措施,通气模式为同步间歇指令通气+压力支持+呼气末正压(SIMV+PS+PEEP),采用小潮气量肺通气保护策略,病情逐日好转,无多器官功能降碍发生,2月6日痊愈出院.结论 早发现、早诊断、早治疗是成功救治高致病性H5N1人禽流感的前提,小潮气量加最佳PEEP通气策略改善氧合是治疗的关键.

A discussion about the tactics of mechanical ventilation for acute respiratory distress occuring in the first case of influenza A (H5N1) in Guizhou Province

Objective To discuss the tactics of mechanical ventilation in a human severe case of influenza A (H5N1) complicated with acute respiratory distress syndrome CARDS). Methods The data of the patient infected by the influenza A (H5N1) admitted to People's Hospital of Guizhou Province on January 15, 2009, were analyzed and summarized. Results The patient, a 29-year-old man, had been healthy in the past, but had exposed to the environment of bird flu before illness. The initial symptom was unremitting high fever, and then the clinical situation deteriorated progressively with occurrence of dyspnea. Pulmonary infiltrates were evident in the left lower lobe on January 19, and rapidly progressed to involve bilateral lungs presenting ARDS-like changes. Mechanical ventilation became the most important treatment among others. The ventilation mode was synchronized intermittent mandatory ventilation (SIMV) + pressure support (PS) + positive end expiratory pressure (PEEP), following lung protective ventilatory strategies, with low tidal volume. The patient's condition improved day by day without developing multiple organ dysfunction. The patient fully recovered and was discharged on February 6. Conclusion Early detection, early diagnosis, and finely effective intervention are to improve oxygenation by mechanical ventilation with low tidal volume and adequate PEEP are critical to reducing the mortality.