Professional Degree Master Degree Thesis
Unit code: Classification number:
Student ID: Secret Level:
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Master Thesis
Analysis of severe pneumonia caused by unknown virus
College (Department, Institute
Graduate name
major
Degree type
mentor
The First Clinical Medical College of Kunming Medical University
Li Xu
Clinical Medicine, Emergency Medicine
degree
Professor Qian Chuanyun
May 2013
Tail slightly
Master Thesis
Analysis of severe pneumonia caused by unknown virus
Applicant's last name Li Xu
Discipline, specialty, 丨 clinical medicine, emergency medicine
Type of degree applied for Professional degree
Professor Qian Chuanyun
Completion Date May 2013
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Research the research results. The paper does not include other people or people except for the places specially marked and acknowledged
Research results that have been published or written by other institutions. My colleagues who have contributed to this research and paper
In the paper made a clear explanation and expressed gratitude. If the dissertation information is not true, I would like to
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Year and month
English acronyms
English abbreviations English full name Chinese full name
body temperature
Pulse rate
breath rate
blood pressure
Heart rate
Computed tomography
Reaction protein
Procalcitonin
Serum amyloid
Dimer
Fibrin degradation products
CO2 partial pressure
〇 Blood oxygen partial pressure
Hydrogen ion concentration index
〗) Oxygenation index
Body response level classification
Urinary natriuretic peptide
Polymerase chain reaction
Human immunodeficiency virus
International standardized ratio
Electrocardiogram
DNA
R N A
r i b o n u c l e i c a c i d
RNA
International Virus Classification Committee
Acute respiratory distress syndrome
Severe acute respiratory syndrome
Coronavirus
Coronavirus
Intensive care unit
table of Contents
Chinese Abstract
English summary
Comprehensive analysis
references
Articles published during degree study
Kunming Medical University Master Degree Thesis
Analysis of severe pneumonia caused by unknown virus
Graduate student: Li Xu
Tutor: Professor Qian Chuanyun
Department of Emergency Medicine, the First Affiliated Hospital of Kunming Medical University,
Summary
Years, months, and months, our hospital successively admitted patients with severe pneumonia caused by unknown viruses. this
The patients were all workers in the same mine and were exposed to a large number of bats and bat feces in the working environment. Final result
One patient died, and the other survived. According to the Kunming Institute of Zoology, Chinese Academy of Sciences, this patient worker
The bat in the mine is the Chinese chrysanthemum, but in the process of searching for pathogens, Chinese scientists
A coronavirus was extracted from the Chinese chrysanthemum bat (. This article aims at cases
The diagnosis and treatment of unknown virus-associated severe pneumonia and the possible etiology and etiology of the person
and analyse .
Keywords: severe pneumonia, bat, coronavirus
Kunming Medical University Master Degree Thesis
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Kunming Medical University Master Degree Student Thesis
Case one
The patient is week, male, and years old.
Chest pain, hiccups, more than one day "was the main complaint and was admitted to the hospital. The patient went to the mine to work for more than half a month, every day
About hours. After exposure to the mine environment and a large number of bats and bat feces, fever, cough, and body temperature appear
After reaching °, immediately go to the local hospital for treatment, and then have fever intermittently, the specific treatment is unknown, body temperature
The highest rose to, the lowest dropped to °, accompanied by dizziness, headache, tinnitus. Cough is dry, no obvious
Circadian rhythm, accompanied by chest pain. Difficulty breathing progressively worsens. Intermittent hiccup
Not accompanied by nausea, vomiting, abdominal bay, etc. In order to further seek treatment in our department. Since the onset, the patient has poor mental and sleep, poor diet, size
It is normal. Previous denials of "hypertension, diabetes, heart disease" and other chronic medical history, denied "hepatitis, typhoid fever,
History of tuberculosis and other infectious diseases, denial of surgery, trauma, denial of blood transfusion, denial of drug and food allergies, vaccination history is unknown. Physical examination: °, sub-point, sub-point,.
The patient's expression was good, the answers were correct, the nutrition was moderate, and the stretcher was sent to the ward. There was no yellow staining on the skin and mucous membranes of the whole body. The large pupils, such as bilateral pupils, had diameters and were sensitive to light reflection. The breathing power of both lungs is the same, the breathing of both lungs
The sound is thick, and the double lower lungs can be heard and dry sound. The heart rate was divided, the heart rhythm was even, and no murmur was heard in each valve auscultation area.
Abdominal softness, no tenderness, no rebound tenderness or muscle tension. Bowel sounds sub-minutes. The lower limbs are not swollen. Physiological reflex
In, the pathological reflex was not elicited. Auxiliary examination: year, month, day, outpatient blood routine result return:
, Blood red protein, blood biochemical results return, blood ammonia coagulation four results return: all in the normal range. Reminder: Double lung texture increase
Coarse, increased, fuzzy, with multiple nodules of varying sizes, partially Koreanized; extensive lamellar exudation and consolidation of both lungs, lower
The lungs are particularly severe; the mediastinal lymph nodes are swollen and partly Korean.
Initial diagnosis after admission: fever, cough, dyspnea, chest pain, hiccup cause? Hyponatremia;
Causes of abnormal liver and kidney function?
method
Improve relevant auxiliary examination after admission:
Year Month Day Return Tips: The texture of the lungs is thickened, increased, blurred and there are multiple hair sizes
Nodules, partly Koreanized; extensive lamellar exudation of both lungs, especially in the lower lung; mediastinal lymphadenopathy, partly Korean
Change.
Year, month, day, and back: 、 There is no obvious change in the lung lesions compared with the previous, a small amount of pleural effusion on both sides
Kunming University of Nursing Science Master Degree Thesis
The dorsal pleura thickened, and the rest was basically the same as before. , A small amount of ascites can be seen at the scan level. (See the picture below) Year, month, day, bedside chest radiograph tips:, the texture of both lungs increases and blurs, there is a point knot, right lung
The nodular shadow of the front assistant room of Nakano, the left lung portal shadow is slightly denser, please review or further with clinical anti-inflammatory treatment
an examination . , Heart shape is not big. , Double diaphragm is normal. (See bottom left picture) Chest radiographs at the bedside: Years and months: The texture of the double lungs becomes more and more blurred, and the suspicious points are in the meantime, the left lung
The film density of the middle and lower fields is increased, and the images of the double lungs are dense. Please review it after clinical anti-inflammatory treatment. , Active
The veins are tortuous and the heart shape is not large. , The left pleural effusion is to be drained, please combine with the clinical. (See upper right picture) Year month day year month month arterial blood gas analysis (see picture below):
—
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Kunming Medical University Master Degree Thesis
blood sugar
— — — — — Lactic acid
Life Huan
Year, month, day, tumor protein, microchip, iron protein, normal male, microgram, human
Chorionic gonadotropin normal micrograms, free prostate specific antigen normal
Micrograms, sugar chain antigen normal value.
Year, month, and day show back that Feida's test and Wai Fei's test are negative; herpes simplex virus, virus, giant
The cell virus showed negative results; interrupt urine culture negative. Glycated hemoglobin white Yin; regular presentation of stool
Negative; self-immune antibodies and antinuclear antibodies are negative.
Years, months, and days showed that the complement was reduced; urine glucose and ketone bodies were negative;
Year month day one year month day dimer (report month
円), month and day), month 円),
Yue Yue).
Year Month Day Year Month Day Infection related protein (see picture below):
:;
—— —
— — — — —
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!
Year by year
Month month; month mouth month mouth month mouth month mouth month day
DAY DAY
White blood cells (with blood platelets (see picture below)):
Kunming Medical University Master Degree Thesis
—
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with , , ,
Make ‘! Order
,, Percentage and count of lymphocytes (see figure below):
Positive period; one inhibits the auxiliary cells, lymphatic
One bar cell §? All
‘-Value: sex cell § double (slave
‘Shuang Yangxi —‘ Acoustic Pair Cells ’1
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Sputum culture, blood culture negative (three times).
Years and months of blood culture showed that Acinetobacter baumannii was positive and Candida was negative.
The sputum cultured Acinetobacter baumannii, pan-resistant.
Year Month Xian ultrasound tips: a lot of ascites.
Kunming Medical University Master Degree Student Thesis
Year, month, day, ascites to check the tumor cell negative. Gram-positive cocci can be seen in the culture. Ascites routine
Sex, Li Fan's test was negative.
Temperature sheet (see picture below):
Body temperature.
;
Body temperature °
—
. Huan. Huan
The situation of key medication after admission:
Year Month Day Year Month Day (A nylon dial,.
Year Month Day Year Month Day (A nylon dial,.
He died on the first day of the year (a nylon dial,.
Year Month Day Year Month Day Meropenem Needle,.
On the first day of the year, the meropenem needle died.
Vancomycin needles died on the first day of the month.
On the first day of the year, he died of Fuli Kang needle (dose doubled on the first day),,.
On the day of death, acyclovir,.
discuss
The working time for patients to enter the mine is year, month and day, a total of working days.
Patient Admission Time: Year Month Day, Discharge Time: Year Month Day, Actual Hospitalization
Days.
Diagnosis on discharge: severe pulmonary infection; sepsis; septic shock, abdominal infection; respiration
Sudden cardiac arrest.
Discharge situation: death.
Kunming Medical University Master Degree Thesis
The patient and chest radiographs show that the condition is in continuous progress.
The arterial blood gas analysis of the patient suggested that the type of respiratory failure continued during the hospitalization, and the oxygenation index was poor.
The "Berlin Definition" of the year can be definitely diagnosed as. So one of the patient ’s death diagnoses can be tested
Considered as "respiratory failure".
According to recent domestic and foreign literature, blood glucose variability is significantly related to patient prognosis and mortality.
During the treatment of this patient, our department gave intensive insulin therapy to try to control the blood glucose
However, the blood glucose variability of patients is large, and the prognosis is poor.
The patient's tumor protein chip result is positive, indicating that the patient has a "tumor" disease, so it is
The system has an impact.
After admission, the patient showed a continuous downward trend with the curve chart.
Shows that the percentage and count of patients, lymphocytes, lymphocytes, and lymphocytes will be in a reduced state. Therefore also
It indicates that the patient's immune function is impaired, the disease resistance is poor, and it is easy to cause nosocomial infection after admission.
On the day of the patient's death, blood culture and sputum culture suggested Acinetobacter baumannii, a large amount of fluid in the abdominal cavity, and ascites
Gram-negative cocci can be seen in the culture, and the related protein should be infected on the day of death.
Therefore, one of the diagnosis of patient death can be considered as septic shock (severe lung infection, abdominal
Cavity infection).
Dimers (month and day respectively) after admission
Month Day), Month Day), Month Day), Absolutely bedridden after admission, and is a tumor patient. The patient's blood oxygen saturation was significantly reduced two days before death
Examination of acute pulmonary thromboembolism
Possibly, due to the critical condition of the patient, it is not appropriate to go out for chest enhancement examination, so "acute pulmonary infarction is not
Can rule out the cause of death. After the patient's death, the family refused to perform an autopsy.
The situation of medication, after meropenem was stopped, no antibiotics were used, and the body temperature
There is now an upward trend. Therefore, antibiotics play a key role in the course of the patient's disease.
Analysis of the cause of death: The oldest of the patients who died was a patient with tumor disease, low immunity, and weak resistance to the disease. The acute onset of this disease is fierce.
Kunming Medical University Master Degree Thesis
Case two
Patient Lu, male, years old, suffered from fever, coughing for half a month
"Nan Tian" was the main complaint and was admitted to the hospital. The patient worked in a pothole before illness and had been exposed to a large amount of bat waste.
He is feverish at first, the body temperature is °, accompanied by coughing, slightly iron embroidered sputum, with blood clots, feeling bloating, anorexia, irritability.
After the infusion in the clinic did not improve, he was transferred to Yuxi City People's Hospital for treatment. During the period of fever, body temperature, fever
Irregular, no chills before fever, still coughing, slightly embroidered, and bloody. Difficulty breathing in the day, worsening after activity, with chest tightness, no chest pain, can lie on the ground, no night-time dyspnea, no abdominal pain, no
Gross hematuria. Previous denials "Hypertension, diabetes, coronary heart disease, cerebral infarction and other medical history. Born in Zhao, Yunnan
Tong, who has been to Mojiang before, and the patient worked in a pothole before getting sick
Have been exposed to large amounts of bat waste. There are people among colleagues
There is a class of patients. Denied the history of "hepatitis, typhoid fever, tuberculosis" and other infectious diseases, denied the history of blood transfusion, denied the history of allergies, and the history of vaccination is unknown. Physical examination: ° sub-point, sub-point, generally poor, flat car pushed into the ward, graded. The facial features are not deformed, and the mouth and eyes are not skewed. double
The lateral pupils are of equal diameter and are sensitive to light reflection. Soft neck, no resistance, centered trachea, bilateral
The rib cage is symmetrical, the breath sounds of both lungs are thick, and the sound of wet breath can be heard at the bottom of both lungs. The heart is not big, the heart rate is sub-pointed, the rhythm
Qi, no pathological murmur was heard. The abdomen was soft, without tenderness and rebound tenderness, the liver and spleen were not reached, and the bowel sounds were subdivided.
There were no cutaneous epidemics and eschars all over the body. The lower limbs are not swollen. The muscle strength and muscle tone of the extremities are normal. Pathological signs (1. Supplement
Help check: Yuxi City People's Hospital Year, month and day Tip: Severe pneumonia in both lungs, more obvious than before
Increase. Emphysema is limited to the lower lobe of the left lung, and bullae of the right lung;
. Blood gas analysis in our hospital, oxygenation index
Lactic acid, blood potassium, blood sodium.
Initial diagnosis after admission: severe pneumonia; type respiratory failure; sepsis; chronic hepatitis B.
Methods (Partial loss of this case, lack of data) Improving related auxiliary examination after admission:
Year, month, day, chest, plain scan back display:, the texture of the lungs is increased, blurred, and the two lungs are seen more evenly
Distribution of small nodular shadows, and exudate in sheets. The mediastinal lymph nodes are enlarged, the heart shadow is not large, and the large blood vessels are not abnormal.
(See picture below left)
Kunming Medical University Master Degree Thesis
Guo Yun
Year, month, day, plain scan, back to show: After treatment of double lung infection, compared with year, month, old film:
Interstitial changes in both lungs, interstitial exudation in both lungs, and unclear changes in proliferation focus; a small amount of pericardial effusion is the same as before; Yu Tong
old movies . (See the picture on the upper right) Year, month, day, chest plain scan back display:, the texture of the two lungs is increased, the blurry performance is the same as before, and the two lungs are more
The hair is evenly distributed in the nodules, and the flakes exuded slightly and improved. , Enlargement of mediastinal endolymph node is same as anterior, and heart shadow is larger than anterior.
Year Month Chest plain scan: 、 Increased texture of both lungs, blurred performance as before, more than two lungs
The hairs were evenly distributed with small nodular shadows, and the sheet exudation was less obvious than before. The mediastinal lymph nodes are roughly the same as anterior, and the cardiac vessels are the same as anterior.
Year, Month, Chest, plain scan, back: The texture of both lungs is increased and blurred, and the lung is diffusely distributed.
Nodular flaky high-density shadow, blurred border, roughly the same as anterior, left pulmonary basal segment limited emphysema; lung
The portal structure is clear, the trachea is unobstructed, the mediastinal lymph nodes are the same as the anterior, and there is no effusion in the pleural cavity.
Year, Month, Chest plain scan, back display:, Interstitial changes of both lungs and scattered exudation and increase in both lungs
The change in colonization is not obvious. The heart shadow is not large, and the lymph nodes are enlarged in the mediastinum.
Year, Month, Day, Bedside Chest X-ray: 、、 Diffuse patchy fuzzy shadow and miliary nodular shadow of both lungs, double
Hilar shadow structure is not clear, the nature is to be determined, please combine clinical analysis
Further clarify . , Heart shape is not big. ,
There was no obvious abnormality in the double diaphragm.
Year and month Xian bedside chest radiographs show:, The diffuse patch shadows and miliary nodular shadows of the two lungs are more advanced than before, please combine the clinical. , Poor observation of heart shape. No obvious abnormalities in the double diaphragm. , The deep vein is placed in the distal position
On the right, the first help room.
The comparison between the year and month Xian and the year and month Xian chest radiograph. ( See below )
Kunming Medical University Master Degree Graduate Thesis
"
Arterial blood gas analysis (see picture below):
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Infection-related proteins (due to lack of data, no table analysis):
Kunming Medical University Master Degree Thesis
Year Month Day Infection-related protein display hypersensitivity reaction protein (, serum
Amyloid (.
Years, Months, Days, Days, Days, and Years
Serum amyloid (.
Year Month Day Infection-related protein Echoing hypersensitivity reaction protein (, Jianghansu
The original (serum amyloid protein (.
Year Month Day Infection-related protein Echoing hypersensitivity reaction protein (, Jianghansu
The original (, serum amyloid protein (.
Year Month Day Infection-related protein Echoing hypersensitivity reaction protein (, Jianghansu
The original (serum amyloid protein (.
Year Month Day Infection-associated protein Echoing hypersensitivity reaction protein (, calcitonin
The original (serum amyloid protein (.
There were no obvious abnormalities in the four blood coagulation four-year indications.
Year Month Day Year Month Day Blood biochemical response showed low hypoproteinemia, but Yu was not obvious
Hall
towel
Year, Month, Day, Blood, Fibrinolysis, Three items, Fibrin, Fibrin, Degradation products (, antithrombin,).
Year Month Day Three items of blood-filled fibrinolysis Show back fibrin Fibrinogen degradation products (, antithrombin,
Year Month Day Year Month Day Blood routine showed no obvious abnormalities.
Year, month, day, urine routine negative.
Year, month, and day muscle wasting protein was negative.
year month day .
Year Month Day Erythrocyte sedimentation rate (.
Year Month Day Normal Value, Complementary Normal Value —
Years, months, and days, Feida's and Wai Fei's tests were negative.
Year Month Day Hepatitis Virology Feedback Quantitative, Quantitative,
Quantitative. Hepatitis B antigen is positive.
A normal copy of the virus was tested positive on year, month and day.
Kunming Medical University Master Degree Graduate Thesis
Negative test on year, month and day.
Detection of negative sex on year, month and day.
,, And cell percentage and count (see figure below):
Auxiliary Judgment — ■ Tied Office
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Temperature sheet (see picture below):
Body temperature.
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body temperature
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— — — — — ■ — — —
two two ! :
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— — —
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■ ■ ■
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Kunming Medical University Master Degree Thesis
The situation of key medications after admission (due to the lack of cases, it is impossible to clarify the treatment situation:
Year Month Day Year Month Day
Year Month Day Year Month Day
Ganciclovir sodium needles,,.
Year Month Day Year Month Day Meropenem Branch,.
Voriconazole,,,.
Remote consultation record
Consultation time: year month day
Location of consultation: Attached to the consultation center of the first hospital.
Consultation expert: Chief physician Xie Canmao, Department of Respiratory Medicine, the First Affiliated Hospital of Sun Yat-sen University.
Director Xie Canmao listened to the report of the medical history and the patient's relevant examination data as a diagnosis:
Severe pneumonia (possible fungal infection? Possible viral infection?); Type respiratory failure; sepsis;
Chronic hepatitis B.
At present, the patient can complete the test, fiberoptic bronchoscopy and other examinations, and the situation allows a feasible lung biopsy, but the patient is currently using a non-invasive ventilator to assist breathing, so this examination is currently not available. Treatment agrees with our department
For the current treatment, it is recommended to add compound sulfamethoxazole sleeping tablets, oral administration, the next day, fluconton anti-fungal, thymosin-improving immunity therapy.
Remote consultation record
Consultation time: year month day
Location of consultation: Attached to the consultation center of the first hospital.
Consultation expert: Shi Jin, Department of Occupational Poisoning, Shanghai Pulmonary Hospital.
Director Shi Jin listened to the report of the medical history and the consultation after seeing the relevant examination data of the patient
Consultation; further diagnosis and treatment in the respiratory department; patients currently do not consider pneumoconiosis. The treatment agreed with our current treatment and plan.
discuss
The working hours of patients in the mine are year, month and day, a total of working days.
Patient admission time: year month day, discharge time: year month day, actual residence
Kunming Medical University Master Degree Thesis
Hospital days.
Diagnosis on discharge: respiratory and cardiac arrest; severe pneumonia; type respiratory failure; sepsis;
Chronic hepatitis B.
Discharge situation: death.
Patients and chest radiographs can see the condition is continuing to progress.
The arterial blood gas analysis of the patient suggested that the type of respiratory failure continued during the hospitalization, and the oxygenation index was poor.
The "Berlin Definition" of the year can be clearly diagnosed. So one of the patient ’s death diagnoses can be tested
Considered as "respiratory failure".
During the hospital, the percentage and count of lymphocytes in the hospital were significantly reduced.
The patient's immune function is impaired, the resistance to the disease is poor, and it is easy to cause hospital infection after admission.
Hepatitis virology suggested chronic hepatitis B after admission.
Due to the lack of patient medical records, a comprehensive analysis was not possible. )
Kunming Medical University Master Degree Thesis
Case two
The patient, Guo Nan, is years old.
"Fever and fever week" is the main complaint. The patient entered the cave a few days ago and continued to inhale unknown gas
After the body (details are unknown), cough, sputum, chest tightness, shortness of breath, fever, and yellow cough appear before the week
Green sticky sputum, — mouth, day, appointment, chest tightness, shortness of breath when resting, body temperature fluctuates
Fearless chills and chills before fever, accompanied by headache, sore limbs, given "antipyretics" (specific
(Unknown) After that, the body temperature can be reduced to normal; the sputum turned into white sticky sputum a few days ago, and bloody blood appeared in the sputum, which was pale
Red,-mouth day, go to the local clinic for treatment, and give "antibiotic" specific details, after a little blood
Stopped, and the remaining symptoms did not improve significantly. I came to the emergency department of our hospital for treatment and performed chest examination:
The texture of the lungs is increased and blurred, the leaflet interval is thickened, and there are multiple small nodules and flocculent exudation, and there are multiple swellings in the mediastinum
Large lymph nodes, given "cephalosporin acupuncture needles," anti-infective treatment days, "methylapatite needles, patients complained that the symptoms were slightly better than before, and the body temperature fluctuated-for further
Diagnosis and treatment, outpatient department "Inhalation Lung Injury" income in our hospital. No chest pain, syncope, or cough throughout the patient's course
Pink foamy sputum, symptoms of paroxysmal dyspnea at night, mental, diet, and sleep, normal bowel movements, weight loss of about kg. Diagnosed with intestinal obstruction in previous years "underwent surgical treatment (specific details are not available). No
Drug Recognition
I have no special. Physical examination: °, sub-point, sub-point,
Mental state is fair, neck is soft, no resistance; cyanosis of lips and fingers, positive thoracic shape
Often, there is no widening of the gap, and there is no tenderness in the chest wall; the blood oxygen saturation of the lungs without oxygen inhalation is unvoiced when the lungs are percussed. Luo Yin. There was no bulge in the precardiac area, no lifting apical beats, a small heart boundary, sub-heart rate, and no pathological murmur in each valve area. belly
Ping soft, no tenderness, rebound pain and muscle tension, liver and spleen less than, lower limbs are not swollen. Auxiliary inspection: years
On the chest of our hospital on the day of the month: the texture of the lungs is increased and blurred, the leaflet interval is thickened and multiple nodules
And flocculent exudation, there are many swollen lymph nodes in the mediastinum. Year Month Day Blood routine in our hospital:
, Percentage of neutrophils, absolute value of neutrophils,
Blood red protein. .
Initial diagnosis after admission: aspiration lung injury; severe pneumonia.
method
Improve relevant auxiliary examination after admission:
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Year, month and chest show: double lung texture, thickening, thickened leaflet interval and seeing more small
Nodules and flocculent exudation: multiple swollen lymph nodes in the mediastinum. Heart shadow is not big. No pleural effusion. ( See below ) ?
Year, month, chest: The texture of the lungs is increased, thickened, and the interlobular septa thickened and seen more than before
Hair nodules and flocculent exudation were not significantly changed from before; the mediastinum was more swollen and enlarged. Yu Jimu is the same as before. (See
Pavilion) Year, month, day, chest show: the right lung has a lobed exudate that is slightly absorbed than before, and the interlobular septum in the remaining lungs thickens and
See multiple small nodules and flocculent exudation, and multiple swollen lymph nodes in the mediastinum approximately the same as before. ( See below )
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Year enhanced 3D reconstruction shows: the texture of both lungs is clearer than before: right lower lungs leaf-like exudation
The shadow is absorbed more anteriorly, and the lungs are more susceptible to small nodules and flocculent shadows than the anterior absorption, and there are more swollen lymph nodes in the mediastinum.
丨 "Front. Pulmonary arteries and human branches have not seen the exact allowable defect. (See Bu Tu) Guo Sui
Years of chest; double lung lines appear more and more thick, thick, fuzzy, broad leaflet septum
United, double lungs see increased film vitreous density and 丨 saka emphysema. Above is interstitial changes in both lungs
Infection, pneumoconiosis can, please combine with occupational diseases. (See winter
Kunming Medical University Master Degree Thesis
Chest radiograph of year, month and day: comparison with old film of year, month and day: interstitial changes in both lungs, with diffuse nodular shadows, partial fusion of lesions, bilateral hilar shadows thickened, and lesions slightly advanced
For exhibition, please combine clinical analysis. (See picture below) Circle
Year Month Day Chest show: Double lungs with spotty fuzzy shadows and exudative solid changes, a small amount of chest on the left
Cavity effusion, moderate pleural effusion on the right, more infections are considered above, it is recommended to review after treatment. See small in the mediastinum
Lymph node shadow, enlarged pulmonary artery trunk, enlarged heart shadow, aortic wall calcification, and left coronary artery with stent shadow. (See below
Figure)
Kunming Medical University Master Degree Thesis
Year Month Day Chest shows: interstitial fibrosis of both lungs, emphysema is basically the same as before; right lower lung dorsal
The segmental or posterior segment of the flakes is really patchy, it is recommended to review after treatment. (See picture below) Year, month, day, chest Show: Lung lesions are more pronounced than before.
Year, month, day, chest show: diffuse lungs grid-like, dot-like shadow, multiple mediastinal lymphadenopathy
Compared with the year and month Xian film, there is no obvious change. (See the picture below) Year, month, and year chest plain radiograph shows: interstitial changes in both lungs, diffuse dot knot shadow, patchy shadow, double hilar shadow thickening, infection consideration, other lesions to be excluded clinical.
Year Month Xian chest plain film shows: diffuse lungs grid-like and dot-like high-density shadow, right lung lower field
Consolidation of some internal bands is possible, please combine with clinical analysis.
Year, month, day, chest show: diffuse lungs grid-like, dot-shaped shadow, multiple mediastinal lymph nodes
There was no obvious change in the swelling compared with the year, month, and day. (See picture below)
1? "J J 丨 University of Science and Technology: Graduate Student Thesis
Year Month 丨 ”Chest: The signs of interpulmonary interstitial pneumonia or interstitial fibrosis are more obvious than before; increase
The rest of the cardiopulmonary mediastinum is the same as above. Pulmonary arteries 丨 and its large branches did not show exact filling defects.
Chest plain radiograph: interstitial changes in both lungs, outer lungs in the middle and upper lungs, and double flaky lungs
Blurred shadow, the old film in the same year is slightly better than the focus, please combine with the comprehensive clinical analysis. (See left
(Picture) Dragon
Look at Cao
Chest plain radiograph: interstitial changes of both lungs, outer bands of upper and middle lungs, and slices of double lower lungs
Blurred shadow, the lesion progresses earlier, please combine clinical comprehensive analysis. (See upper right pavilion) Year chest plain film shows: the texture of both lungs is more and more blurred, and the problems are scattered in the point knot, right lung midfield
The sheet density is high, and the lesions are more advanced than before; the two hilar shadows are dense and the structure observation is not clear. Please combine with the clinic.
(See Zuo Pavilion) ■ Sincerely ■
Nian's chest radiograph shows: the right upper lung infection lesion is more absorbed than the front, the right lung midfield infection lesion
More advanced than before; the images of the double lungs are dense and the structure is not good. Please combine with the clinic. The lesion of the left lung field infection is more developed than before, the left hilar, the diaphragm top and the costal diaphragm angle are unclear, and the left chest wall is not taken into the film.
Diagnosis. (See upper right page) Year-year oral arterial blood gas analysis (see figure below):
HKUST, Master Shu: Research Papers
: — —
: — —
Factory ‘
;
丨
— 【、. - One one one
— — — — —
- - One -
One — — one ■ —
— —,
Wide Bu —
— — 2
:,,,,,,,,,
,,,,,,,,, Bu Yi —
- One
- - - One - -
— — — — — —
—
—
— —
— — ■ “‘ “■
—
— — —
- - - One - - - "
— — —
Production-Bu 2 2
,,, — — Two, one, two
— 、 、 、 卜 Bu 、 、
, One one
— — — — —】〉】
— — — — —
Two:
Infection-related protein (see Bu Wen):
—
— —— — —
—
— ■ —
"
Years 』Etiology testing: Wiping paper, whole blood testing, epidemic blood fever,
After the fever, Japanese encephalitis, virus-related viruses.
Kunming Medical University Master Degree Thesis
Year Month Day Test Negative
The tumor protein chip was negative on year, month and day.
Year Month Day Year Month Day Blood routine showed no obvious abnormalities.
Year Month Day Year Month Day No obvious abnormalities in urine routine.
Year, month, day, year, month, day, blood coagulation The four examinations showed no obvious abnormalities.
Year Month Day Year Month Day There were no obvious abnormalities in the blood-filled fibrinolysis.
Year Month Day Year Month Day No obvious abnormal blood biochemistry.
Year, month, and day type natriuretic peptide feedback.
Year, month and day type natriuretic peptides are displayed.
Year, month, day type natriuretic peptides are shown back.
,, Cell percentage and count (see figure below):
;: ‘‘ ’:
Positive inhibition of the period assists fine lymphatic lymph
： ―Color cell box — 丨 — are fine —
: Value:, Value-oriented fine application ■ Double (, Shuangyang ‘value — cell). —
丄 丄 丄 丄 丄
丄 丄 丄 丄 丄
丄
丄 丄 丄
■
■ ■ round round
Country Country Yuan
Year Month Day Deep Vein Catheterization
Year Month Day Deep Vein Catheterization
Deep vein catheterization
Year Month Day Catheterization
Kunming Medical University Master Degree Thesis
Year Month Day Non-invasive ventilator-assisted ventilation.
Year Month Day Non-invasive ventilator-assisted ventilation.
Year Month Day Ventilator assisted breathing.
The sputum culture, sputum smear, and blood culture are all negative.
Year Month Day Sputum culture Candida glabrata.
The sputum culture, sputum smear, and blood culture are all negative.
The sputum smears showed gram positive cocci and gram negative cocci.
The sputum culture of Acinetobacter baumannii was positive on year, month and day, and only levofloxacin and amikacin were sensitive.
The sputum culture, sputum smear, and blood culture were all negative.
The sputum culture was positive for Acinetobacter baumannii in sputum culture.
The sputum culture of Acinetobacter baumannii was positive on year, month and day, and only levofloxacin and tobramycin were sensitive.
The sputum culture of Acinetobacter baumannii was positive on year, month and day, and only levofloxacin and tobramycin were sensitive.
The sputum culture and blood culture were negative on year, month and year.
Year Month Day Sputum culture Acinetobacter baumannii positive
Only levofloxacin is sensitive.
The sputum culture of Stenotrophomonas maltophilia is mostly sensitive.
The sputum culture was positive for Acinetobacter baumannii (twice).
Years of blood culture Acinetobacter johnsonii, most antibiotics are sensitive (twice).
Years of blood culture showed that Acinetobacter baumannii and Candida culture were negative.
Years and months sputum culture negative.
Temperature sheet (see picture below):
Body temperature.
— — —
Kunming Medical University Master Degree Thesis
Key medications after admission:
Hold the Jiaxiang needle in the head,
Cefoperazone talibatan needle.
Year Month Day Year Month Day Nelacillin tazobactam needle.
Year Month Day Year Month Day Piperacillin talib batan needle,.
Vancomycin needle and needle,.
Cefoperazone sulbactam,,.
Year Month Day Year Month Day Meropenem Needle,.
Levofloxacin needle needle,.
Year Month Day Year Month Day Cefoperazone Tazobactam needle.
Cephalosporin tamil batan needle.
Levofloxacin tablets,.
Fosfomycin needle,.
On the first day of the month, the racillin he defeated the batan needle.
On the first day of the year, he died.
On the first day of the month, he died.
Year Month Day Year Month Day (A nylon dial,.
Year Month Day Year Month Day (A nylon dial,.
Year Month Day Year Month Day ⑴ A nylon dial needle.
Year Month Day Year Month Day (A nylon dial,.
Year Month Day Year Month Day (A nylon dial,.
Nylon, Nylon, Nylon,.
Nylon, Nylon, Nylon,.
Year Month Day Year Month Day (A nylon dial,.
Year Month Day Year Month Day (A nylon dial,.
Year Month Day Year Month Day (A nylon dial,.
Nylon, Nylon, Nylon,.
Year Month Day Year Month Day Nylon film.
Kunming Medical University Master Degree Thesis
Year Month Day Year Month Day (A nylon dial,.
Year Month Day Year Month Day (A nylon dial,.
Year, month, year, month, month, and month.
Year Month Day Year Month Day (A nylon dial,.
Year Month Day Year Month Day (A nylon dial,.
Year Month Day Year Month Day (A nylon dial,.
He died on the first day of the year (a nylon dial,.
Year Month Day Year Month Day Caspofungin Needle.
Year-on-day Day-on-month Day Flucone fell.
Micafungin,.
On the day of death, Fukang died of a needle.
Ganciclovir,.
On October 1st, he died of oseltamivir phosphate tablets.
Ganciclovir died on the first day of the month.
Thymus peptide,,.
Thymus peptide,.
Remote consultation record
Consultation time: year month day
Location of consultation: Attached to the consultation center of the first hospital.
Consultation expert: Chief physician Xie Canmao, Department of Respiratory Medicine, the First Affiliated Hospital of Sun Yat-sen University.
Chief physician Xie Canmao listened to the report of the medical history and the patient's relevant examination materials, and the consultation opinion was the diagnosis
Off: Interstitial pneumonia with a high probability of fungus. At present, patients can re-complete the test, fiberoptic bronchoscopy, etc.
Examination, the situation allows a feasible lung biopsy, but the patient is currently using a ventilator to assist in breathing, so for now
Can do this check. The treatment agreed with our department's pre-treatment, it is recommended to add compound sulfamethoxazole tablets, oral administration, the next day, Fulicone anti-fungal, thymosin-improving immunity treatment.
Kunming Medical University Master Degree Thesis
After the above consultation opinions were reported to Director Qian Chuanyun, Chief Physician Qian Chuanyun, Chief Physician Wang Yunhui and Liu
Rong Deputy Chief Physician decided to switch to caspofungin combined with fluconazole after anti-fungal treatment. Compound sulfonamide
A moxa tablets and Ridaxian treatment. At present, the patient has fever and considers combined with bacterial infection.
Sulphurone sulbactam and merlotoxan strengthen anti-infection.
Remote consultation record
Consultation time: year month day
Consultation location: Affiliated consultation center (remote consultation).
Consultation expert: Academician Zhong Nanshan, Department of Respiratory Medicine, the First Affiliated Hospital of Sun Yat-sen University.
The academician Zhong Nanshan listened to the report of the medical history and the patient's relevant examination materials and the consultation opinion was diagnosed as:
Interstitial pneumonia
Viral possibility is high; invasive pulmonary aspergillosis (secondary). Academician Zhong Nanshan recommended
Before: Go to Kunming Institute of Zoology to determine the type of bat; Do a pharyngeal test and antibody test;
, Treatment with caspofungin, cefoperazone sulbactam and meropenem;, Strengthening airway management, using fiberoptic bronchoscopy
Sputum suction (no water injection and lavage is possible. I agree with my subject's current plan for treatment.
The above consultation opinions were examined after consultation with Professor Qian Chuanyun, Chief Physician Wang Yunhui and Deputy Chief Physician Liu Rong
Consider the antifungal treatment of patients switched to caspofungin, meropenem and ceftazidime sulbactam combination therapy.
discuss
The working time of patients in the mine is year, month and day, a total of working days.
Patient admission time: year month day, discharge time: year month day, actual residence
Hospital days.
Discharge diagnosis: severe pneumonia; multiple organ failure; aspiration lung injury;
Interstitial pneumonia (virally likely); invasive pulmonary aspergillosis (secondary).
Discharge situation: death.
Patients and chest radiographs can be seen repeatedly, in a state of fluctuating progression, and eventually lung disease
Becomes the outcome of pulmonary fibrosis.
The arterial blood gas analysis of the patient indicated that the type of respiratory failure continued during the hospitalization, and the oxygenation index was poor.
The "Berlin Definition" of the year can be clearly diagnosed. So one of the patient ’s death diagnoses can be tested
Considered as "respiratory failure".
Kunming Medical University Master Degree Thesis
The percentage and count of patients, lymphocytes and lymphocytes decreased significantly, suggesting that the patient's immune system was damaged, therefore, the resistance to this disease was poor
It is easy to cause "nosocomial infection" after admission. During the hospital stay
Deep vein catheterization was performed twice, and later blood culture and sputum culture were both indicated as "Acinetobacter baumannii".
Infection-related protein Protonogen (recall) Therefore, one of the diagnosis of patient death is considered as
Septic shock (caused by severe lung infection.
According to the Critical Care Branch of the Chinese Medical Association, the diagnosis and diagnosis of invasive fungal infections in severe patients
"Guide to Treatment", we can consider this patient with secondary invasive pulmonary aspergillosis.
Medication situation: meropenem needle is stopped on the day of the month, the head is stopped on the day of the month
The patient's body temperature increased after the day of selefenadine and batan.
Net, indicating that there is a high possibility of secondary bacterial infection in patients, the application of antibiotics is necessary.
After the patient's death, our doctor suggested that the patient's family member should be autopsied to determine the cause, but the patient's family member refused.
Analyze the cause of death: The patient's immunity is obviously low, and his resistance to the disease is weak. This disease is acute
Onset, rapid development. Later combined with nosocomial infection.
Kunming Medical University Master Degree Thesis
Case 4
The patient Liu Nan, aged, was admitted to the hospital on the basis of "cough, sputum, fever days, and difficulty breathing days". The patient had been working under the mine a few days ago.
When measuring bat width and bat width stool, cough and sputum began to appear a few days ago, accompanied by bloody sputum, not much, and fever, the highest temperature reached ° °, and felt chest pain.
The specific medication is unknown. The above discomfort symptoms did not alleviate. He went to the emergency department of our hospital yesterday for treatment. patient
Difficulty breathing is obvious. He was admitted to the hospital for further diagnosis and treatment. Since his onset, he has a poor mental diet and no special stool.
Previous physical fitness, denied "hypertension, diabetes, heart disease" and other chronic medical history. Have been to Mojiang before the patient
Worked in potholes and had been exposed to large amounts of bat waste. Some of my colleagues have a similar medical history. Denied "hepatitis,
History of infectious diseases such as typhoid fever and tuberculosis, denying history of blood transfusion, denying history of allergies, denying infections such as "tuberculosis and typhoid fever"
History of illness, no history of trauma and blood transfusion, denial of history of drug allergy, ominous history of vaccination. Physical examination: °,
Sub-point, sub-point, generally poor condition, bilateral pupils are of equal circle, straight
The diameter is reflected by light, the lips are sweet, the neck is soft, the breath sounds of both lungs are thick, and the middle and lower lungs can be heard and thick
Wet rales, sub-scores, luqi, no obvious murmurs were heard. Abdominal softness, rebound tenderness without tenderness, bowel sounds
Secondary points, normal muscle strength of limbs, normal muscle tone, bilateral bilateral Pap sign (I. Outpatient data: years
Month and day show: The texture of the lungs is thickened, increased, blurred, and diffuse large flaky exudative consolidation is seen.
Initial diagnosis of admission:,;, The nature of the double lung disease is to be investigated?
method
After admission, improve the related auxiliary examination:
Year, month, day, chest plain scan: double lungs texture increased, fuzzy, multiple flakes of both lungs
Change, obvious in the lower lobe of both lungs
It is recommended to review after treatment. Bilateral pleural effusion. ( See below )
Kunming Medical University Master Degree Degree Theory
Year, month, and year, chest plain scan: compared with the year, month, and day old film: increased lung texture,
Blurred, multiple lamellar exudative solid changes in both lungs are reduced compared to anterior absorption. The bilateral pleural effusions were slightly absorbed than before. (See
The following figure ) -
Chest enhancement on the year, month, and day, chest enhancement showed enhanced scan of the main pulmonary artery and left and right pulmonary artery trunks. No abnormalities were seen in the bilateral upper and lower pulmonary artery branches. Considering acute pulmonary embolism, please combine clinical practice.
There were multiple ground glass exudates in both lungs, the lower lungs showed consolidation, and a small amount of pleural effusions on both sides. (See picture below) Year, month, day, chest plain radiograph: double lung texture increased, hilar structure normal, double lung mid-low field lung pattern
Li Zengduo was blurred, and there were some patchy shadows in the middle, and small patchy shadows in the right lung. (See picture below left)
Kunming Medical University Master's degree theory
Year Month Day Chest plain film shows: double lung infection, please review with clinical interval. (See upper right picture) Year, month, day, chest plain radiograph: Compared with year, month, day, radiograph: Compared with exudative lesion of right lung
Significant progress was made before, and the exudative lesion of the left lung was slightly absorbed than before. (See the picture on the lower left) ￥
Year, month, day, chest plain film shows: bilateral lung exudation lesions and year, month, day
Absorption, please combine clinical. (See upper right picture) Year, month, day, chest enhancement: Shows that the absorption of left lung inflammation is obviously reduced; now the lower right lung is consolidated
Signs, please review after treatment. (See picture below) ￡
Year, month, day, chest enhancement Tip: Compared with year, month, day, film: right lung consolidation is more
There was a slight absorption before, and there was an increase in ground glass-like density in both lungs, which was considered as exudation. Enhanced scans are not obvious
Often. ( See below )
Kunming Medical University Master Degree Thesis
Take the risk of Peng Yuqing — 丨 佳
—
Year Month Day Chest plain scan: Compared with Year Month Day film: Right lung consolidation and empty
The cave image is slightly absorbed than before, and the double lung ground glass-like density is increased.The shadow is reduced and the density becomes lighter than before.It is recommended to continue treatment
Review after treatment. (See the picture below) Year, month, day, chest plain scan: right lung consolidation is slightly heavier than before, empty cavity is absorbed before, double lungs
The increase in the density of frosted glass decreases and the density becomes lighter than before. Right pleural effusion is slightly more than before, cardiopulmonary mediastinum
I changed basically the same as before. ( See below )
Kunming Medical University Master Degree Student Thesis
Year Month Day Chest Plain Scan: Compared with Year Month Day Old Film: Texture of Double Lungs
Blurred more anteriorly, consolidation of right lung is more severe than anterior, consolidation of left lung exudation is greater than anterior range, right pleural effusion is more anterior
Slightly more, the heart shadow is slightly larger than before, and the mediastinum is basically the same as before. (See the picture below) Year, month, day, chest plain radiograph: right lung flaky exudation and consolidation, right pleural effusion.
Year Month Day Chest plain scan shows: double lung texture increased and blurred, double lower lungs see fluffy fuzzy
Shadow, the effective volume of the right lung is reduced, and fluid is seen in both pleural cavity
The rightmost pleural effusion is about the widest. The right lower lobe shows a large dense patch with airy bronchial signs in it. The right pleural cavity shows drainage tube retention. (See
(Pictured below) —— 一 —…
Year Month Day Chest plain scan shows: The texture of both lungs increases and blurs, the ground glass of the lungs exudates, right
Consolidation of the upper and lower lobes of the lungs, the tracheobronchial cavity is unobstructed, consider infection, please combine clinical. Medium amount of pleural effusion on the right side and a small amount of pleural effusion on the left side. Enlarged lymph nodes in the mediastinum. (See the picture below) Year, month, day, chest plain scan: double lung texture increased blurry, ground glass exudation Same as before, right
The upper and lower lobes of the lungs are the same as before. The right side of the gas has been absorbed, the right side of the pleural effusion, the left side is basically the same as before. ( See below )
Kunming Medical University Master Degree Thesis
Chest radiograph on year, month and day showed that the exudative lesions of both lungs were absorbed more than before, the right side was obvious, and the infection might be.
The right pleural effusion may be. (See picture below) Year, month and day Chest plain scan shows: large flakes seeping solid changes in right lung, and air bronchi in them
Signs of the tube, multiple punctate, small exudative shadows and cord strip shadows in the left lung, a small amount of pleural effusion on both sides and external pressure lung
Atelectasis; there are many small lymph nodes in the mediastinum, and there are no abnormalities in the heart shadow and large blood vessels. (See the picture below) Year, month, and chest scan: The pleural effusion and lung atelectasis change roughly the same as before. ( See below ) - --
E called 丨 owed: Master of Science University 丨: graduate student, thesis
Year film-year arterial blood gas analysis (see figure below):
One -- - : : - :
‘Guang’ —
;; Today 丨 Guang ■::::: — —
——
Discuss
■!丄 ■ 丨 ■, ‘
‘―? ‘―
① Bu
Two two; ■, —
— — —
— — —; — — — — ——
— ■: —: — —
— —— ■… ■ Ya:
— “— —:‘, —
— — ——;
"-Fly" Blood Sugar
■; Example-Lactic acid. 』
— — —— —; ■ — ——
— —
‘―‘ ― — ‘― — —‘ ― — —
— ‘―‘ ‘‘ — ① ① — ‘,‘ ‘― Bu Bu ■
'three two ::! ’① ① ① ： 卜
" " ,One - - -
,,,, Two,,,,,,,,,,,
- - - - - One
■ ‘“ — — —
Year Month Day Year Month Blood Routine Leukocytes (curve, residual test results
If no obvious abnormalities are seen (see the figure below):
— —
‘丨‘ 丨 ‘‘
〒 "It's —
— 【‘々 —
- '- " - - - mouth
:
■ 丄 ￡; ‘卜 卜 卜 ■ Two‘ two
, —, ■ ■, ■ ■
,,,,,,,,
— One — one —
— — — —— — — — ‘― —
Kunming 丨: HKUST
Master's Studies ± Degree Thesis
Year Month Day Year Month Day Myocardial enzymes and feedback showed no abnormalities.
Quantification of immunoglobulin protein and complement is measured and displayed, and complement is displayed.
Year, month and day Hepatitis toxicology complete set and syphilis show negative.
Year Month Day Simple Pain Virus Cytomegalovirus Papilloma Virus Detection
Negative .
Placed on year, month and day.
Year tracheotomy.
Year, Month, Day, Chengdu Military Region Disease Prevention and Control, Heart Disease Original Test (pharyngeal wipes and whole blood)
Negative .
Perform thoracic drainage puncture under ultrasound guidance on year, month and day.
Year, month, day, pleural effusion routinely show bloody appearance, Li Fanta test positive, red blood cells,
WBC, monocyte ratio, multinuclear cell ratio.
Year, month, and day, pleural buffaloes show back adenosine deaminase, total protein, glucose
, Chlorine.
Year Month Day Routine pleural effusion showed bloody appearance, Li Fanta test was positive, red blood cells,
White cell, mononuclear cell ratio, multinuclear cell ratio.
Year Month Day Pleural effusion Biochemical display of adenosine deaminase, total protein, glucose
, Chlorine.
The cytology examination of cerebrospinal fluid showed that neutrophils increased in response.
Year Month Day Cerebrospinal fluid cytology showed mixed cell response.
Year, month, day, urine routinely show ketone body, urine occult blood.
Year Month Day Urinary routine showed back urine occult blood.
Year, month, day, stool routinely show occult blood positive.
The year, month, day, urine routine test negative.
The situation of white egg whites (see the figure below), the remaining biochemical indicators are not clear
Abnormal.
Kun called "University of Science and Technology Master Bachelor Degree Thesis
Egg wide
:
A ■ ;;
： ‘： ： ； ； ： ： 工
■ ‘; — ■‘ 丨 丨,:. 〒:, "
:, ■ one
■ ‘‘ ■ ”‘ ‘eight”
But Bu "—.
— ― ‘—
‘‘ —
■ Two Two Two
— ‘■‘
— — —
— — —: —
Year — year month day blood 楽 dimer (see picture below):
丁 — 丁 〒 Bian up —
① 々 Bu —
— —
— —
— — —; ‘卜‘ — — —
”2 ① Bu 2
,,,, One, one, one, one, one,,,
- One -
— — ■ — —
Years-years 丨 international standardized ratios during anticoagulant therapy (see
BU]):
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,
》
,,,,,,,,,,,,,,,,,,,,,,,,
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Small, ten, small,
‘
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Theories of Research Degree
—Year 丨 Infected eggs (Buge):
One -
!
One ; ,- "
— —
—
, — —
—
— Year by year
,, Cell white ratio and count (see cabinet):
Date Positive Suppression Fine Auxiliary Fine Deer Fine Deer-Lymphatic
Lymphocytes are all (1
Financial value One-to-one view of yang-type paralysis (—Yang fine-pair value—cell) —absolute value Litong wake up :::
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丄 丄 丨 丄 丄
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Year 丨 丨 Lack of training 丨 "丨 Demonstration.
Year 丨 Blood culture traceability.
Year 丨 sputum culture 丨 『』 Bowman moving rod orchid.
Year 丨 sputum culture showed that Bowman did not move rod orchid, drug sensitivity showed that amyloid is sensitive.
Years 丨 Fatigue cultivated Shi Bao's surname flutter, drug sensitivity Shiami! Star sensitive.
Year 丨 sputum culture shows Bauman moving rod 丨.
Kunming Medical University Master's Degree Student Thesis
The sputum culture shows Acinetobacter baumannii and Escherichia coli.
The sputum culture showed that Acinetobacter baumannii was cultured on each year.
Year Month Day Blood culture shows Klebsiella pneumoniae subspecies pneumonia.
Year, month, day, blood culture (aerobic anaerobic) returned negative.
Temperature sheet (see picture below):
Body temperature °
丨 one
① Bu inch — bu inch — ⑦ ①; ① ①
— — — — — — —
① ① ① Bu Bu
—
— — — — — —
Key medications after admission:
Year Month Day Year Month Yen (Methylprednisolone Needle,.
Year Month Day Year Month Day (Methylprednisolone needle.
Year Month Day Year Month Day (Methylprednisolone needle.
Year Month Year One Year Month Latch (Methylprednisolone Needle,.
Year Month Day Year Month Day ⑴ Methylprednisolone needle.
Year Month Day Year Month Day (Methylprednisolone Needle
.
Year Month Day Year Month Day (Methylprednisolone needle.
Year Month Day Year Month Day (Methylprednisolone needle.
Year Month Day Year Month Day (Methylprednisolone,.
Year Month Day Year Month Day Prednisone acetate tablets,,.
Year Month Day Year Month Month Prednisone Acetate Tablets,.
Ganciclovir needle,.
Kunming Medical University Master Degree Thesis
Year Month Day Year Month Day Acyclovir needles,,.
Ganciclovir needle,.
Year Month Day Year Month Day Voriconazole needle.
Year Month Day Year Month Day (Itraconazole Capsules,.
The first dose of fluconazole needle doubled every year, month, year, and year).
Year Month Day Year Month Day Caspofungin Needle.
Year Month Day Year Month Day Caspofungin Needle.
Year Month Day Year Month Day Itraconazole Tablets,.
Voriconazole tablets,.
Moxifloxacin Needle,.
Year Month Day Year Month Day Meropenem Needle,.
Linezolid needle,.
Year Month Day Year Month Day Cefoperazone sulbactam needle.
Cefoperazone Tazobactam Needle,.
Cefoperazone sulbactam needle.
Year Month Day Year Month Day Meropenem Needle,.
Year Month Day Year Month Day Piperacillin Tazobactam,.
Levofloxacin tablets,.
Year Month Day Year Month Day Low molecular weight heparin,.
Year Month Day Year Month Day Warfarin Films.
He was discharged from the hospital on the first day of the month.
He was discharged from the hospital on the first day of the month, with low molecular weight heparin.
year month day , .
Flunaroxanol,.
Thymus peptide needle,.
Kunming Medical University Master Degree Thesis
discuss
The working time for patients to enter the mine is year, month and day, a total of working days.
Patient admission time: year month day, discharge time: year month day, actual residence
Hospital days.
Diagnosis on discharge: Interstitial pneumonia; Severe pneumonia; Hypoproteinemia.
Discharge situation: improved.
During the hospitalization, the arterial blood gas analysis drawing showed that the early admission was type of respiratory failure and poor oxygenation index. According to the content of the "Berlin Definition" of the year, the diagnosis can be clearly determined.
The patient was admitted to the hospital in a critical condition and the respiratory function improved after tracheal intubation and ventilator-assisted ventilation, but
Suddenly the oxygenation index decreased on the day of the month, and symptomatic treatment such as adjusting the ventilator parameters was performed.
Good. Month day after admission is month day for and
The reason for this low oxygenation status is unknown, so he was strengthened in emergency department on the day of the month.
Low density filling defect is seen in the vein branch Considering acute pulmonary embolism, our department immediately added low molecular weight heparin,
The day after the antithrombotic treatment with warfarin, the patient's respiratory function was significantly improved, indicating that anticoagulation and antithrombotic treatment have
Effect. During the anticoagulation treatment, according to the international standardized ratio (adjusting the amount of warfarin, the adjustment appears
Once, use antagonistic treatment immediately.
Oxygen reduction began again on the day of the month, and the body temperature suddenly rose. Since the patient was admitted to the hospital on the day of the month
In the Medication Act, voriconazole, ganciclovir and methylprednisolone were continuously used for treatment, but stopped on the day of the month
Moxifloxacin was used without antibiotics, so he considered that this respiratory insufficiency was caused by aggravation of lung infection, and it was displayed on the day of the month, and melopenem and linezolid were added immediately. Month day trip
Examination prompts: "The large area of the lower right lung is actually changed. Two sputum cultures on the month and the day showed that Acinetobacter baumannii was positive and blood culture was negative. After taking the drug, the patient's body temperature showed a downward trend.
Said chest enhancement suggests that the consolidation of the right lung is slightly absorbed than before. Respiratory function improved significantly.
Month Day Reexamination of the chest Tip: Frosted glass-like density increases in both lungs and voids appear. Suffer
The body temperature continued to fluctuate between °, considering the possibility of secondary "invasive pulmonary aspergillosis", Yue Yue
Show back, add (Itraconazole capsules for oral treatment. Patient relapses on month and day
However, there is a poor oxygenation. Since the diagnosis of acute pulmonary embolism on the day of the month, our department has taken daily anticoagulation measures, and
Month day back to back, back to now, do not consider the recurrence of acute pulmonary embolism, pulmonary infection may be more serious. Because the patient's condition is always in critical condition, and the current diagnosis and treatment are not clear,
Kunming Medical University Master Degree Thesis
Year, month and day, please invite the chief physician Xie Canmao of the Department of Respiratory Medicine, the First Affiliated Hospital of Sun Yat-sen University to have a remote video consultation. The opinions after the consultation are: Diagnosis of interstitial pneumonia, high possibility of fungi; Invasive pulmonary aspergillosis (secondary);
Pulmonary embolism. At present, patients can be further improved by tests, fiberoptic bronchoscopy, etc.
Examination, but the patient is currently using a ventilator to assist in breathing, so this examination is currently not available. Agree on treatment
Our department's pre-treatment, it is recommended to add compound sulfamethoxazole tablets, oral, the next day, voriconazole anti-true
Bacteria, thymosin enhance immunity therapy. After consultation, our department considered that the patient had been treated with voriconazole for the previous period, and the antifungal drug was switched to caspofungin combined with fluconazole. Measured on the day of the month, the day of the month is the day of the day
The increase in the glass-like density of the lung ground glass shrinks and the density becomes lighter than before, considering that antifungal treatment is effective.
During treatment, the patient's body temperature still fluctuated between °, although nutrition, ventilation in the prone position,
Treatment of lung expansion and other treatments, but still can not be separated from the support of the ventilator, fortunately invited to Sun Yat-sen University on
Zhong Nanshan, a member of the Department of Respiratory Medicine of the First Affiliated Hospital, has a remote video consultation. The consultation opinion is diagnosis: interstitial pneumonia, which is highly likely to be viral; invasive pulmonary aspergillosis (secondary. It is recommended to determine the bat at the Kunming Institute of Zoology
Bat type; do pharyngeal dipstick test and antibody test; use caspofungin, cefoperazone sulbactam and
Treatment with meropenem; strengthen airway management, use sputum suction with fiberbronchoscope (no water injection and lavage)
Try to go offline.
I therapeutically agree with our department's current plan.
Month Day Chest plain scan shows that the texture of both lungs is more blurred than before, the consolidation of the right lung is more serious than before, and the left lung is infiltrated
The consolidation range is larger than before, and the right pleural effusion is more than before. "
Drainage puncture, and the pink pleural effusion was tested, and the result was shown as exudate (non-tuberculosis
Or neoplastic). Continue the above-mentioned remote consultation treatment plan. Month day, month day
It shows consolidation of the upper and lower lobes of the right lung, the same amount of pleural effusion on the right side, and a small amount of pleural effusion on the left side. Continue to close the chest
Pleural effusion. At the same time correct the patient's hypoproteinemia.
The patient's oxygenation index has been maintained at about 2 days, hemodynamics is stable, and there is autonomous breathing
Ability, after voluntary breathing test and airway assessment, the metal sleeve was successfully removed.
The patient's body temperature suddenly increased on the day of the month, and no direct cause was found.
Show and consider that the current antifungal drugs have been used, but antibiotics have not been applied, and immediately added piperacillin tazobactam, levofloxacin tablets, and the body temperature of the patient recovered after treatment.
Often.
In the late stage, the chest plain scan showed that the right lung was atelectasis and the pleural effusion was significantly absorbed than before, but the left lung was still
Kunming Medical University Master Degree Thesis
There are some exudative real changes.
The percentage and count of patients, lymphocytes, and admissions were significantly lower in the early, middle, and early stages of hospitalization.
Treatment, and the patient's own immune system improved, and various indicators in the later period basically returned to normal.
During the hospitalization, our department strictly controlled the random blood glucose of the patients to minimize the blood
Sugar variability.
Monthly test blood culture (aerobic anaerobic) returns negative, monthly test infection-related protein returns
, The patient's lung infection has basically returned to normal.
Body temperature fluctuates around ° every day, and the patient has cough, expectoration, chest pain, dyspnea, and limb pain
The symptoms have disappeared, so our department discontinued all but the "anticoagulant" drugs. The patient succeeded on
Discharged.
Kunming Medical University Master Degree Thesis
Case five
Patient Wu, male, years old, with "cough, sputum, fever, chest tightness,
"Qi Tian" was the main complaint of the Department of Respiratory Medicine of our hospital. The patient had no obvious cause of cough before the day before
Mainly cough, occasionally cough a small amount of white mucus sputum, sputum is easy to cough out, and it is chilly and feverish, and there is no obvious time for fever every day
Regular, the highest body temperature reaches °, with headache, sore limbs, feeling chest tightness, shortness of breath after light activity, rest
It can be relieved later. No coughing up blood, chest pain, no palpitations, night sweats, fatigue, no syncope, difficulty breathing at night,
Puffiness. No diagnosis and treatment after the illness, yesterday I went to the emergency department of our hospital for treatment.
The nature of the nodular shadow is to be investigated "and admitted to our department. Since the onset, the patient's mental, diet, sleep, and stool
Normal, no significant increase or decrease in body weight. There have been recent copper mine work history. The patient had entered
Working days in caves where bat waste is measured. No previous special medical history, no history of drug allergy. Physical examination:
°, sub-point, sub-point, clear, lips and fingertips without cyanosis, thoracic shape
Normal state, no tenderness in the chest wall, blood oxygen saturation without oxygen inhalation, no leukoplakia in the oral mucosa, double lung percussion presentation
Unvoiced sounds, thick breathing sounds in both lungs, a little wet rales can be heard in the lower left lung, and no wet and dry rales in both lungs. heart
The rate was divided into sub-regions, no pathological murmur was heard in each valve area, and no enlargement of heart-bound percussion. Abdomen is soft, no tenderness,
Rebound pain and muscle tension, the liver and spleen were under the costal ribs, and there was no puffiness in both lower limbs. Auxiliary inspection: year month day
Show: Both lungs and lungs are scattered in the miliary nodular shadow, and the double lower lungs are frequently infiltrated.
Initial diagnosis of admission: double lung exudation, nodular shadow to be investigated? (Possible aspiration pneumonia; silicosis to be discharged) Method
Results of related auxiliary examination after admission:
Year, month, day, and chest in our hospital showed: both lungs and lungs scattered in the miliary nodules, and double infiltration of the lower lungs
Appearance. Enlarged lymph nodes in the mediastinum. (See picture below left)
Kunming Medical University Master's Degree Thesis
Year, month, day, chest back display: The two lungs are scattered in the nodular shadow of the millet, and the double lower lungs are more oozing than before. (See
Upper right picture) Year, month, day, chest, back: diffuse disease in both lungs is better than before. Mediastinal lymph nodes
small . (See picture below) Year Month Day Year Month Day Blood routine, blood biochemistry, arterial blood gas analysis, myocardial enzymes,
There were no obvious abnormalities in the four items of blood coagulation.
The year, month and day test is negative.
Year, month and day showed that the sinus rhythm was slow, and no obvious abnormalities were seen.
Infection related proteins: Month Day), Month Day),
Month Day ) ,
Month Day), Display Month Day),,,,
Month Day ) .
,, Cell percentage and count (see figure below):
Positive positive suppression cells helper cells lymphocytes
Lymphocytes are all cells
Opposite value Absolute value Positive sex cell double
Shuangyang fine absolute value positive cell) absolute cell value
■
Temperature sheet (see picture below):
Kunming Medical University Master Degree Thesis
Body temperature °
』丨 Body temperature.
——
— —
Life
Key medications after admission:
The application of sulbenicillin needles and needles.
Voriconazole needle and needle,.
Year Month Day Year Month Day (Methylprednisolone sodium succinate needle,.
Needle branch of prednisone,.
Year Month Day Year Month Day Hydroprednisone Needle Branch,,.
Year month day year month month latch prednisone acetate tablets,.
Discharged on the first day of the year, prednisone acetate tablets
As soon as he was discharged from the hospital on the first day of the month, the thymus peptide needles.
discuss
The working time for patients to enter the mine is year, month and day, a total of working days.
Patient admission time: year month day, discharge time: year month day, actual hospitalization
Days.
Diagnosis on discharge: multiple nodules in both lungs, the nature of exudation to be examined (possible lung histoplasmosis; silicosis
Row.
Discharge situation: improved.
The patient is a young patient. After admission, he was treated with anti-infection, anti-inflammatory and anti-fungal treatment, and his condition improved without fever.
Cough, sputum, chest tightness, and shortness of breath symptoms recur. The patient did not use "antiviral" drugs in the course of the disease, and the condition is good
Turn, indicating that the body's own immunity plays a key role in the course of the disease.
Kunming Medical University Master Degree Thesis
The patient's monthly scan showed that the condition was getting worse, so he added antifungal drugs and hormones.
After reexamination of the chest, the exudative consolidation on the lungs was significantly improved, and the patient's body temperature dropped to normal, indicating anti-fungal and
Hormone therapy is effective.
Discuss the reasons for the patient's survival: the patient is a young patient with strong autoimmunity and short working hours under the mine.
Treatment is timely and effective.
Kunming Medical University Master's degree thesis
Case six
Patient Li, male, years old, suffered from "cough, sputum, fever with episodes
Difficulty breathing difficult days is mainly admitted to the hospital. The patient had worked in the mine a few days ago, and there were a lot of bats and
Bat stool, with an irritating smell, the patient had cough, sputum and fever since the beginning of the day, and the sputum was white sputum
Fluid, body temperature up to °, difficulty breathing when coughing, denial of chest pain and hemoptysis, denial of paroxysmal nighttime breathing
Difficulty with aspiration, denied abdominal pain and diarrhea
Come to our hospital for further treatment. The patient is in good health, denying that "hypertension, diabetes, heart disease" and other slow
History of sexually transmitted diseases. Before the onset, he worked in the mine and was exposed to a lot of bat feces and inhaled irritating gas
Infectious diseases such as inflammation, tuberculosis and typhoid fever and their contact history; denial of history of drug and food allergies; vaccination
History is unknown. Physical examination: body temperature °, pulse fraction, breath fraction, blood pressure.
Normal development, moderate nutrition, no yellowing of skin and mucous membranes throughout the body, and no superficial lymph nodes in the body. Facial features
There is no deformity, the pupils of both sides are equal in size, and there is reflection of light. No cyanosis on the lips, no resistance on the neck, centered trachea, and no thyroid enlargement. Both sides of the thoracic cage were symmetrical, the breathing sounds of both lungs were thick, and no wet and dry rales were heard. No abdominal examination
Obviously abnormal. There was no puffiness in both lower limbs. The limbs of the spine are not deformed, with normal activities and normal muscle strength. Physiological reflexes exist, but pathological reflexes are not induced. Auxiliary examination: the chest of our hospital shows: the texture of the lungs is thicker, more and see more hair
Granular nodules, pneumoconiosis and acute blood-borne tuberculosis or other lesions are to be identified, and enlarged lymph nodes are seen in the mediastinum.
Initial diagnosis of admission: cause of fever? (Possible lung infection); Aspiration lung injury; Hypokalemia
Symptoms.
method
Improve relevant auxiliary examination after admission:
Year and month Chest plain film shows: the texture of both lungs is confusing, the miliary nodules are diffuse in both lungs, nature
Please combine the comprehensive analysis of clinical and other examinations. The heart and diaphragm are normal. ( See below )
Kunming Medical University Master Degree Thesis
Year Month Day Chest plain scan shows: The texture of the lungs is slightly more and fuzzy, and the original lungs have multiple miliary knots
Arthroplasty was reduced compared to the anterior, with a little fibrous skein in the posterior basal segment of both lungs and a thick left pleura.
Year Month Day Chest plain scan back: Compared with Year Month Day: The texture of both lungs is slightly more,
Blurred, multiple miliary nodular shadows in the original lungs were reduced compared to the anterior, and a few fibrous cords in the posterior basal segment of the lower lungs were anterior
The reduction, local emphysema and marginal pulmonary bullae were the same as before. Heart shadow is not large, swollen shower can be seen in the mediastinum
Fuck. (See picture below) Year, month, day, chest plain scan: the texture of the lungs is slightly more and fuzzy, and the original lungs have multiple miliary knots
There was no obvious change in the arterial shadow compared to the previous, a little fibrous cord shadow, local emphysema and marginal lung in the base of the lower lobe of both lungs
Big bubble etc.
Year, month, day, enhancement, showing diffuse lung disease, tuberculosis? ), The change is not obvious than before;
The pulmonary artery is slightly thicker. (See the picture below) Year, month, day, chest plain scan: The texture of the lungs is slightly more and fuzzy, and the original two lungs have more miliary shadows.
Significantly reduced anterior and decreased, a little fibrous cord shadow in the posterior basal segment of both lungs, local emphysema, and marginal lung enlargement
Kunming Medical University Master Degree Thesis
Bubble wait. (See the figure below) Year, month, day, blood routine, blood biochemistry, blood coagulation, myocardial enzymes, no obvious abnormalities.
Year Month Day Blood biochemical feedback,
Year, month, day, and four items of hepatitis virology, urine routine, and blood coagulation showed no abnormalities.
Years, months, days, etc. are normal.
Years, months, and days of blood routine, blood biochemistry, myocardial enzymes, and blood culture showed no abnormalities.
Arterial blood gas analysis,, and oxygenation index
, Blood sugar, lactic acid.
Year Month Day Arterial blood gas analysis showed that, oxygenation index
, Blood sugar, lactic acid.
Year Month Day Plasma fibrinolysis three indications, antithrombin,
Infection-related protein feedback on the year, month and day,,
.
Temperature sheet (see picture below):
Body temperature °
丨 Body temperature
Life
Kunming Medical University Master Degree Thesis
Key medications after admission:
Ganciclovir,
Year Month Day Year Month Day Piperacillin tazobactam sodium.
Year Month Day Year Month Day (Methylprednisolone needle,.
Year Month Day Year Month Day (Methylprednisolone needle,.
discuss
The working time for patients to enter the mine is year, month and day, a total of working days.
Patient admission time: Year Month Day, discharge time: Year Month Day, actual residence
Hospital days.
Diagnosis on discharge: lung infection; aspiration lung injury; hypokalemia.
Discharge: improved.
The patient is a young patient. After admission, he was treated with anti-infection, anti-inflammatory and anti-viral treatment.
The line was significantly reduced to normal, without cough, sputum and paroxysmal dyspnea. This patient has not used
With "antifungal" drugs, the condition improved
Explain that the initial onset of the disease is very unlikely to be caused by a fungal infection.
The comparison of the patient's before and after films suggested that the condition on the lungs improved significantly before and after treatment.
Discuss the reasons for the patient's survival: the patient is a young patient, has strong immunity, and has short working hours under the mine.
Treatment is timely and effective.
Kunming Medical University Master Degree Thesis
Comprehensive analysis
1. Pathology:
Viruses are a type of non-cellular micro-organisms that are small in form and simple in structure and contain only one type of nucleic acid or that must be parasitic in living cells and proliferate by replication. According to the nucleic acid type of the virus
The structure is divided into viruses, and viruses, according to the shape of the virus body, are divided into: Paramyxoviridae,
Orthomyxoviridae, Retroviridae, Parvoviridae, Coronaviridae, Sarcoviridae, Rhabdovirus
Viridae, Fibroviridae, etc.
Coronaviruses belong to the Coronaviridae systemically. Among them, a variant is caused by "atypical pneumonia"
Of pathogens. Phylogenetic analysis based on viral nucleic acid sequence, International Virus Classification Committee
Ninth Report Lieutenant General Coronavirus
It is divided into four categories, namely,, and new hypothesis (1). Among them, coronaviruses mainly include severe acute
Respiratory syndrome (Coronavirus as well as
Coronavirus (, such as the coronavirus,,,,
And civet coronavirus and so on.
About coronavirus-like (:
As a new coronavirus, it first broke out in Guangdong Province in the country, and in a short time
Spread quickly in the room. Because the virus mainly causes severe acute respiratory syndrome in humans (so it
Coronavirus
Also known as infectious atypical pneumonia. although
There is still no clear answer to the direct host of, but in the traceability process of
A variety of coronaviruses have been isolated from various bats. Among them, separated from the body of the bat
Of coronaviruses have similar genome structure characteristics, and the consistency of nucleotides is very high.
Between, so this kind of coronavirus is called coronavirus-like (or bat
Bat-like coronavirus.
】
Ship Spirit
—
Shanghai
hidden
】
Kunming Medical University Master 丨: Graduate Thesis
It has been reported in the literature that Yuan Guoyong, a microbiologist at the University of Hong Kong in China,
Wendong's horse-hair bats and big-eared bat-headed bats in Tianjin and leather-headed bats in Nanning, Guangxi
To. If the bat carries or, it is possible
The spread of the virus to humans and other animals makes it possible for the virus to spread across species. However, there are reports from
The genome of the isolated in the patient and the animal is located in the bat phylogeny
In a coronavirus-like evolutionary group, these data indicate
From the evolutionary group of bat-related viruses. Therefore, the current research on bat coronavirus has become the current
The hot spot of virus research in the world.
2. "Horizontal" analysis:
And 3 patients have entered the same mine to work, the specific work is to "clean up a lot of bat droppings
"Blood", followed immediately by "different degrees, similar symptoms".
, A patient has admitted to our department (Wu accepted the Department of Respiratory Medicine)
The doctor on duty immediately
The medical department reported the specific situation to prevent the outbreak and epidemic of infectious diseases.
A critically ill patient entered the initial treatment stage of our department, and his respiratory function showed type respiratory failure, that is, pulmonary gas exchange failure, and therefore manifested in the lung interstitial and alveolar lesions.
The percentage counts of cells and cells measured after admission were significantly reduced, suggesting that the patient's immune system
Seriously damaged, and a variety of opportunistic infections can occur. Some scholars have proposed that lymphopenia
Low plays a very important role in viral infection, therefore, it is inferred that this patient may be affected by viral infection
Cause.
After admission, Guo and Liu Yu et al.
Wipes and whole blood), epidemic hemorrhagic fever, dengue fever, Japanese encephalitis, pandemic influenza virus
Virus feedback is negative, but only one negative pathogenic test cannot rule out related viral infections.
, Table tips: The main clinical symptoms of the patients are "cough, sputum and fever", the main partner
The symptoms are "dyspnoea, sore limbs, bloody sputum and headache".
Table tips: The longer the patient works under the mine, the higher the mortality rate. At the same time there is a patient
The patient was a high-age patient, whose earliest death was the earliest. Considering the prognosis, the shorter the working hours and the younger the age, the better the prognosis and the shorter the hospital stay.
, The table prompts: The infection-related proteins in the first measurement after admission of all patients were significantly increased,
Kun National University of Shaanxi Science and Technology Frame Ten Graduate Degree Thesis
All of them are within the normal range, suggesting that this patient may be infected with a virus.
Table Complaints and accompanying symptoms of patients admitted
Symptoms Fever Dyspnea Limb acid Bloody
Cough, sputum, headache, chest pain
Afflicted with: Difficult to hurt phlegm
stomach
Lu
pill
Form Related Important Information
Condition At the time of admission
Working days in the cave
Number of cases (years) Week death Male
Lu death male
Guo death male
Liu improved male
Wu improved male
Li improved male
Yige was infected with related proteins for the first time after admission
Name time
week
Lu
Guo
Liu
Wu
Lee
Quick test of colloidal gold colorimetry in our hospital)
Slightly higher, higher, higher, significantly higher.
Kunming Medical University Master Degree Thesis
, The picture shows the temperature curve of the three dead patients, suggesting that all three patients were in high fever before death
too
,
—
"" ‘;
, ‘
: — — Zhou °
"— Lv °
, ... —
:,,::--
丨 丨 丨, 丨 丨 丨 丨 丨 丨 丨
卜 卜 卜 — ⑦
Right inch
— —
Fig
, The picture shows the blood lactate curve of a critically ill patient during hospitalization
No comparison can be made) .According to relevant domestic and foreign literature reports, blood lactic acid is the key to monitor the condition of critically ill patients.
Effectiveness indicators can be used to assess the severity of hypoxia such as shock and tissue hypoperfusion and to determine prognosis, analysis
The relationship between blood lactate and mortality in this case
The same conclusion can be reached.
— — Zen sense [:,
For, 鋳, ： ”： ； ； ； ： ：
—: — —
Negotiations, —: Sugar
— Zhou lactic acid.
Guo Lactate
① inch 々 ①
Inch inch bu —
— — — —
, Three follow-up patients who were discharged from the hospital by telephone: Patient Liu, although he had been discharged for about a few days, was still at home
Recuperate. Since complaining about poor self-immunity on weekdays and being prone to colds, he actively exercises at home to improve his immunity. Two
One young patient, Wu and Li, had no obvious discomfort after discharge from the hospital, but their own resistance was slightly worse.
, According to Liu, the only critically ill patient cured in this case, a successful cure plan was obtained: This
It is a comprehensive treatment result, providing breathing, circulation, nutritional support, and taking into account the functions of various organs.
The body's acid and alkali, electrolyte balance, to prevent and timely deal with various complications, especially hospital-acquired
Kun Bingshuo University of Science and Technology Bian Shuo Research
Infection.
, Deficiencies and deficiencies: (People with wood disease cases initially passed the Chengdu Military Command Center for Disease Control
The pathogenic test (pharyngeal swabs and whole blood) related virus is negative, but only one pathogenic test is negative
It can eliminate related virus infections. After consultation and sampling by academician Zhong Nanshan in the later period, the Wuhan Institute of Virology
The serum antibody was positive, suggesting the presence of viral infection. Therefore, in the future clinical work
At this point, similar to severe pneumonia caused by unknown virus or collectively-occurring severe pneumonia, you must be alert to infectious diseases.
Can, and cooperate closely with local disease prevention and control centers to complete the prevention, clinical and even department of such diseases
Research work; (A total of three patients died in Muci cases. Although the lung biopsy was considered before, but due to various
The reason is that there is no successful lung biopsy. At present, the rate of lung biopsy biopsy for pathological diagnosis is about
Or Ultra-localized lung biopsy is more risky for severe patients, so the transbronchial bronchus can be considered
Microscope biopsy, although the diagnosis rate is lower than direct lung biopsy, but it may also be a try; (obtained in the preventive hospital
Acquired infection is the top priority of the work; (considering that this patient is the same in varying degrees
The disease, despite the successive deaths, but the family of the patient still refused to perform an autopsy, and the medicine has improved
It is inseparable from anatomy and pathology. I hope that in the future medical law, "Unknown cause of death:"
Considering the infectious disease, the dead body needs to be dissected immediately and report the test results "; the first two patients die
I haven't collected the blood sample and left a sample for the purpose of finding the cause and doing the relevant examination and scientific research; (consider this
The cause of this patient's illness may be caused by inhalation of a large amount of volatile gas from bat feces or exposure to a large number of live bats, so it is of great significance to sample and test bat feces and live bats in the mine.
3. Research direction
In recent years, scholars at home and abroad have continuously found that both in viral and bacterial infections
Elevated, but little or no significant increase in viral infection. Lack of sensitivity to viral infections
Sensitive, but can be increased in the early stages of bacterial and viral infections. The joint detection of the two can improve the virus sense
Diagnosis efficiency during the infection period, and provide useful parameters for the identification of viral and bacterial infections and the selection of treatment options
Examination information, and with the widespread and reliable application in the past two years, it has become a
New markers — can we find some potential relationships with them? Therefore, further research is needed.
, About bats: The research on has never stopped.
High status, they have found the important position of "Chinese chrysanthemum bat" in the spread, and
Kunming Medical University Master Degree Thesis
The bat that caused this human illness has been identified as "Chinese chrysanthemum bat" by the Kunming Institute of Zoology, Chinese Academy of Sciences.
However, researcher Shi Zhengli of the Institute of Virology, Chinese Academy of Sciences, and researcher Zhang Shuyi of the Institute of Zoology, Yu Yu
Published a joint study in the "" magazine in 2015 and concluded that "bats carry but
The conclusion is that it will not directly infect humans ", so the unknown virus that was admitted to our hospital caused the related severe lung
It is a significant and far-reaching subject to conduct research on bats in mines where inflammation patients work.
4. Summary
Based on the above examples and related literatures, this case of an unknown virus causing severe pneumonia is analyzed.
Can be: "or" bat-like "that has been isolated in the body of Zhonghua Ju-headed bat
Caused by "Coronavirus".
Master Degree Thesis of Kunming Medical University
references
,,,,, Jiang Wenzhong, Tang Yan The mechanism of increasing lactic acid in critically ill patients and its value in prognosis
Kunming Medical University Master Degree Thesis
Articles published during master's degree
Li Xu Qian Chuanyun Wu Haiying Guiding treatment of monitoring extravascular lung water pair Kunming Medical Department
University Journal,,
Kunming Medical University Master Degree Thesis
Thanks
As time goes by, Bai Ju has a gap, and at the end of the three-year postgraduate study career,
I have sincerely thanked my mentors, friends and relatives for my care, support and help over the years.
First of all, I would like to sincerely thank my mentor, Professor Qian Chuanyun, for training me for three years. The teacher is very knowledgeable,
Broad-minded, his approachable and affable style of treatment; rigorous and realistic attitude to study, rich in adventurous
Bed experience, superb diagnosis and treatment technology, sharp and active innovative thinking, dare to innovate the scientific research spirit,
The selfless dedication of the career and the kind and selfless care for the students have kept me in mind, and it is my lifelong learning
Model, I am fortunate to have such a teacher in my life. In the past three years, what I have learned is inseparable from grace
The hard teaching of the teacher, I would like to extend the most sincere thanks to the teacher, and wish the tutor good health and good luck
Italian!
Thanks to Director Wang Yunhui, Associate Professor Liu Rong, Deputy Chief Physician Wu Haiying, Deputy Chief Physician Zhang Wei, Wang Jin
Doctors, Dr. Yu Wen, Dr. Xia Jing, etc. gave me careful guidance and help in study and work. here
Sincerely
My most sincere thanks to the teachers!
Thanks to my sisters Liu Jinjin and Zhu Nini, brothers Yang Yaopeng and Luo Zuqian, fellow Tang Shikai and sister Zhang
Great support and support from Jie, Li Xuejiao, Liu Jinling, brother Wang Xiao, Song Guangyu, Li Zhengchao, Yang Dexing
Yes, although we will work and live in our own cities, I will always remember you!
Thanks to the roommates who accompanied me through my three-year master's career, I will not forget to spend with you
Those wonderful nights.
Sincerely thank my family, you will always be my role model and driving force!
Thanks to all the teachers in the Graduate School of Kunming Medical University and the Science and Education Department of the First Affiliated Hospital of Kunming Medical University
Three years of careful cultivation, care and care, and I pay high tribute to the huge labor you have paid!
Thanks to all the teachers and classmates who have cared about and helped me!
Finally, I sincerely extend my most sincere thanks to the review teachers!