以消化道症状为首发表现的妊娠期新型冠状病毒肺炎诊治体会

目的：分析妊娠期新型冠状病毒肺炎（COVID-19）患者的诊治过程，为妊娠期COVID-19的正确诊治提供参考。方法：回顾性分析1例已治愈出院的以消化道症状为首发表现的妊娠期COVID-19患者的一般资料、COVID-19患者接触史、查体、辅助检查、诊断方法和治疗方法等，探讨妊娠期COVID-19快速且正确诊治的方法。结果：患者，女性，38岁，因"停经30⁺²周，腹泻、恶心3d"入院。无明显诱因出现腹泻和恶心等急性胃肠道感染症状，因有武汉市COVID-19患者接触史，行咽拭子核酸检测及肺部CT检查；咽拭子核酸检测阳性；肺部CT检查示，左肺下叶及右肺上、下叶见多发斑片影。临床诊断为COVID-19。治疗过程中严格监测孕妇生命体征及胎儿宫内安危，给予患者中西医结合治疗。治疗后患者各项检测指标好转，痰液及咽拭子病毒核酸检测2次转阴，肺部炎症明显好转，胎心监护有反应型，共住院15 d，母胎安全，痊愈出院。结论：腹泻、恶心和呕吐等消化道症状可能是COVID-19患者的首发症状。CT检查用于筛查疑似COVID-19病例有重要作用，且孕期亦可安全使用。早期、规范的中药联合抗病毒治疗对非重型COVID-19有效。

Diagnosis and treatment of novel coronavirus pneumonia in pregnancy with gastrointestinal symptoms as first manifestations

Objective: To analyze the process of diagnosis and treatment of the patient with novel coronavirus pneumonia(COVID-19) in pregnancy, and to provid the refercnce for the diagnosis and treatment of COVID-19 in pregnancy. Methods: The general materials,COVID-19 patient contact history,physical examination,auxilliary examination,diagnosis methods and treatment methods of a COVID-19 patient in pregnancy, who recovered and was discharged, with the gastrointestinal symptoms as the first manifestations were retrospectively analyzed;the quick and correct diagnosis and treatment methods for COVID-19 in pregnancy were explored. Results: The female patient,aged 38 years old,was hospitalized because of "menelipsis 30⁺² weeks,diarrhea and nausea for 3 d".The acute gastrointestinal symptoms such as diarrhea and nausea were presented without obvious inducement.Because the patient had the contact history of the COVID-19 patients in Wuhan city,pharyngeal swab nucleic acid test and lung CT scan were performed in the patient.The result of pharyngeal swab nucleic acid test was positive,and the CT results showed that the inferior lobe of left lung and the upper and lower lobes of right lung had maltipre speckle shadows.The clinical diagnosis was COVID-19.In the treatment process,the maternal vital signs and the fetal state in utero were monitored strictly.The patient received combined treatment of Chinese and Western medicine.After treatment,the examination indexes of the pregnant woman were improved,and the results of sputum and pharyngeal swab nucleic acid test were negative for consecutive two times;the lung inflammation was improved;the fetal heart monitoring was normal;the time of patient in hospital was 15 d;the patient recovered safely and was discharged. Conclusion: The gastrointestinal symptoms such as diarrhea, nausea, and vomiting may be the first manifestations of the COVID-19 patients.CT examination plays an important role in screening the patients with suspected COVID-19, and it is safe to be used in pregnancy. Early and sufficient Chinese medicine combined with antiviral treatment for non-heavy COVID-19 is effective.