目的

分析新型冠状病毒肺炎（COVID-19）继发糖尿病酮症酸中毒（DKA）合并肝门静脉积气（HPVG）的临床特征和诊疗措施。

方法

回顾性分析2022年2月六安市中医院收治的1例COVID-19继发DKA合并HPVG患者的诊疗经过，并进行相关文献复习。

结果

患者，男性77岁，2022年2月25日以呼吸系统症状为首发表现，多次新型冠状病毒（SARS-CoV-2）核酸（咽拭子）阳性，诊断为COVID-19，外院予抗感染、补液等对症支持治疗。2月27日患者症状加重，伴有纳差、腹胀、恶心呕吐等消化道症状，本院血液相关检查提示DKA、脓毒血症、急性肾损伤，胸部+全腹部CT平扫示：左侧胸腔积液伴左肺下叶膨胀不全，双肺炎性病变；门静脉及分支多发积气，腹腔肠管多发扩张积气、积液，并大小不一液平，腹腔少量积液，考虑肠梗阻。入院后立即急诊剖腹探查术，术后予机械通气，美罗培南（1.0 g、静脉滴注，1次/8 h）+利奈唑胺（600 mg、静脉滴注，1次/12 h）抗感染、化痰、补液、控制血糖、护胃、维持电解质平衡等治疗。患者于2022年2月28日下午呈逸博心律，抢救无效死亡。

结论

COVID-19继发DKA合并肠梗阻、HPVG临床罕见，患者病情危重且病死率高，临床医师需提高对COVID-19肺外并发症的认知，尤其是胃肠道症状，早期诊断和治疗，改善预后。

Objective

To investigate the clinical features and treatment measures of diabetic ketoacidosis (DKA) complicated with hepatic portal venous gas (HPVG) secondary to corona virus disease 2019 (COVID-19).

Methods

The diagnosis and treatment process of a case of DKA combined with HPVG secondary to COVID-19 admitted to Lu’an Hospital of Traditional Chinese Medicine in February 2022 was analyzed, retrospectively, and relevant literature was reviewed.

Results

A 77-year-old male patient presented with respiratory symptoms as the first symptom on February 25th, 2022, and was diagnosed as COVID-19 after multiple positivity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)nucleic acid (pharyngeal swab), and received symptomatic supportive treatment such as anti-infection and fluid rehydration in other hospitals. On February 27th, 2022, the patient’s symptoms worsened, accompanied by digestive tract symptoms such as poor appetite, abdominal distension, nausea and vomiting. Blood tests in our hospital indicated DKA, sepsis, acute kidney injury. Chest and abdomen computed tomography (CT)scan showed left pleural effusion with left inferior lung hypodilation and double pneumonia. Multiple gas accumulation in the portal vein and branches, multiple expansion of the abdominal intestine, gas accumulation and fluid accumulation, and different sizes of fluid, a small amount of fluid accumulation in the abdominal cavity, intestinal obstruction is considered. Emergency exploratory laparotomy was performed immediately after admission, and mechanical ventilation was given after operation. Meropenem (1.0 g, intravenous drip,one time every 8 h) combined with Linezolid (600 mg, intravenous drip, one time every 12 h) for antiinfection, phlegm reduction, fluid replenment, blood sugar control, stomach protection and electrolyte balance were also given. On the afternoon of February 28th, 2022, the patient developed a heart rhythm and died.

Conclusions

DKA secondary to COVID-19 combined with intestinal obstruction and HPVG is clinically rare in critical condition and have a high mortality rate. Clinicians need to improve their awareness of extrapulmonary complications of COVID-19, especially gastrointestinal symptoms, in order to get early diagnosis and treatment to improve the prognosis.