【摘要】 1例71岁女性患者,因慢性支气管炎急性发作,接受抗炎、平喘、祛痰等药物治疗及无创呼吸机辅助通气,病情曾一度好转,鼻导管吸氧2L·min-1时SaO2可维持在93%～98%。于治疗过程中间断发作室上性心动过速,遂予小剂量胺碘酮持续泵入(30mg·h-1,720mg·d-1),应用5d后呼吸困难明显加重,需持续使用无创呼吸机,血气:PaCO278mmHg,PaO281mmHg,SaO297%。换用鼻导管吸氧2L·min-1后SaO2迅速降为85%。复查肺CT:左肺多发模糊影,较前范围增大。立即停用胺碘酮,静脉滴注甲泼尼龙40mg·d-1,应用3d后呼吸困难明显减轻,血气:pH7.36,PaCO277mmHg,PaO284mmHg,SaO296%,BE14.6mmol·L-1。6d后肺CT:多发模糊影较前吸收。更多还原

【Abstract】 A 71-year-old female patient came to the hospital with the symptoms of exacerbation of chronic bronchitis. After treatments including antibiotics, antiasthmatics and expectorants, and aided breath by noninvasive ventilator, the symptoms improved temporarily. Received inspiratory oxygen through nasal catheter at the speed of 2L/min, SaO2 was maintained at the level of 93% to 98%. In the course of treatment, the patient experienced paroxysmal supraventricular tachycardia, and then low dose amiodarone (30mg/h, 720mg/d) was pumped in continually. The dyspnea worsened after use of amiodarone for 5 days. Consequently, the noninvasive ventilator needed to be used continually, the blood gas analysis showed that PaCO2 78mmHg,PaO2 81mmHg and SaO2 97% ( mode NIV, FiO2 65%,PEEP 6cmH2O). After changing the noninvasive ventilator to nasal catheter, SaO2 fell to 85% immediately. The recheck of the pulmonary CT showed extensive misty shadow on left lung, and it’s worse than before. So methylprednisolone was given instead of amiodarone at a dose of 40mg daily, the dyspnea relieved significantly 3 days later. The blood gas analysis showed that pH 7.36,PaCO2 77mmHg,PaO2 84mmHg,SaO2 96% and BE 14.6mmol/L as a result of oxygen inhalation through nasal catheter at 2L/min. Six days later,the pulmonary CT showed the misty shadow was absorbed significantly.更多还原