1例青少年新冠肺炎相关重症肺炎纵隔肺炎临床观察

E. Knizhnikova, G. Evseeva, S. A. Cherezov, T. M. Adlivankina, R. Telepneva, S. Suprun, O. Lebedko
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摘要

的目标。1例青少年重症COVID-19相关性肺炎纵膈气临床病例分析材料和方法。本文报道1例青少年新冠肺炎重症期并发自发性纵隔气肿。患者甲某,15岁,1度肥胖,病情严重,于发病第7天入住新冠肺炎患者传染病医院,主诉体温升高至40℃,明显咳嗽乏力,行走和休息时呼吸困难。SARS-CoV-2 PCR检测呈阳性。多层螺旋ct显示双肺多节段间质病变,有多处“磨玻璃”区,纵膈气征,胸部上三分之一皮下肺气肿,左侧胸腔积液。肺组织病变体积右侧占50%,左侧占85%。住院2-3天后未见治疗的积极效果。由于中毒综合征、呼吸衰竭、肺组织炎症改变综合征,病情严重。在这方面,患者静脉注射tocilizumab (Actemra®)400mg。患儿于住院第20天出院,临床效果良好。上述临床病例表明,在儿童中,新型冠状病毒感染不仅严重,而且可能出现纵隔肺炎等并发症,抗菌和抗病毒治疗的效果较低,需要使用人源化单克隆抗体(托珠单抗)。
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Clinical observation of pneumomediastinum in a case of severe COVID-19-associated pneumonia in a teenager
Aim. Demonstration of the clinical case of pneumomediastinum in a teenager with severe COVID-19- associated pneumonia.Materials and methods. The clinical case of spontaneous pneumomediastinum was presented, which was a complication of the severe course of COVID-19 pneumonia in a teenager.Results. Patient Ch., 15 years old, with obesity of the 1st degree, was admitted to the hospital of infectious diseases for patients with a COVID-19 on the 7th day of the illness in a severe condition and had complaints of an increase in body temperature to 40ºC, pronounced cough and weakness, dyspnea when walking and at rest. The PCR test for SARS-CoV-2 gave a positive result. Multispiral computed tomography showed polysegmental interstitial lesion of both lungs, which had multiple areas of “ground glass”, signs of pneumomediastinum, subcutaneous emphysema of the upper third of the chest, left-sided pleural effusion. The volume of lung tissue lesion was 50% on the right and 85% on the left. The positive effect of treatment was not observed after 2-3 days in the hospital. The condition of heavy severity continued due to intoxication syndrome, respiratory failure, inflammatory changes in lung tissue syndrome. In this regard, the patient was injected intravenously with tocilizumab (Actemra®) 400 mg. The child was released on the 20th day of hospitalization with a positive clinical effect.Conclusion. The above clinical case demonstrates that in children a novel coronavirus infection can occur not only in severe form, but also with the possible development of complications in the form of pneumomediastinum and low effectiveness of antibacterial and antiviral therapy, which required the use of humanized monoclonal antibodies (tocilizumab).
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