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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。
A 71-year-old female patient suffered from acute exacerbation of chronic bronchitis, received anti-inflammatory, antiasthmatic, expectorant and other non-invasive ventilation and ventilator assisted ventilation. The condition was once improved. SaO2 at 2L · min- Maintained at 93% to 98%. In the course of treatment, the supraventricular tachycardia was discontinued. Small doses of amiodarone (30 mg · h-1,720 mg · d-1) were continuously pumped in. After 5 days of application, the dyspnea was significantly aggravated. Non-invasive ventilator Blood gas: PaCO278mmHg, PaO281mmHg, SaO297%. For nasal catheter oxygen 2L · min-1 SaO2 rapidly dropped to 85%. Review of lung CT: Multiple left lung fuzzy shadow, the former range increased. Immediate withdrawal of amiodarone, intravenous methylprednisolone 40mg · d-1, after 3 days of breathing was significantly reduced, blood gas: pH7.36, PaCO277mmHg, PaO284mmHg, SaO296%, BE14.6mmol · L-1.6d Lung CT: multiple fuzzy shadow before absorption.