ECMO成功救治先天性支气管动脉-肺动脉瘘引起的致死性大咯血病例报告  

Successful rescue of fatal hemoptysis caused by congenital bronchial-pulmonary artery fistula with extracorporeal membrane oxygenation

作　　者：赵丽 邰子健 王鹏 胡晓波 张静 杨洪娜 宋璇[1] 白雪 张继承 Zhao Li;Tai Zijian;Wang Peng;Hu Xiaobo;Zhang Jing;Yang Hongna;Song Xuan;Bai Xue;Zhang Jicheng(Department of Critical Care Medicine,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,Shandong,China;Shandong University,Jinan 250021,Shandong,China)

机构地区：[1]山东第一医科大学附属省立医院重症医学科,济南250021 [2]山东大学,济南250021

出　　处：《中国中西医结合急救杂志》2022年第4期479-482,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：ELITE合作项目(SWYX:NO.2020-099)。

摘　　要：目的探讨体外膜肺氧合(ECMO)成功救治先天性支气管动脉-肺动脉瘘引起的致死性大咯血患者的诊疗方法。方法回顾性分析山东第一医科大学附属省立医院重症医学科收治的1例先天性支气管动脉-肺动脉瘘引起的大咯血伴窒息患者的临床表现、实验室和影像学检查及治疗过程。结果患者男性,32岁,因无明显诱因出现大咯血入院,除常规积极的对症支持治疗外,入院当天在ECMO辅助治疗下行介入栓塞术,并行气管镜下血凝块洗出,术后患者生命体征逐渐好转;18 d后患者因再次出现大咯血,行介入栓塞治疗。结论大咯血常危及生命,病因复杂,病死率高,需在短时间内止血治疗,改善呼吸衰竭。通过对该病例的诊疗过程进行分析,以期为临床医生治疗大咯血提供借鉴。Objective To investigate the successful treatment of patients with fatal massive hemoptysis caused by congenital bronchial-pulmonary artery fistula with extracorporeal membrane oxygenation(ECMO).Methods A case of massive hemoptysis patient with asphyxia caused by congenital bronchial-pulmonary artery fistula was admitted to the department of critical care medicine,Shandong Provincial Hospital Affiliated to Shandong First Medical University.The clinical manifestations,laboratory tests,imaging examinations and treatment process of this patient were retrospectively analyzed.Results A 32-year-old male patient was admitted to the hospital because of massive hemoptysis without obvious risk factor.In addition to the conventional positive supportive treatment,interventional embolization was performed with ECMO adjuvant therapy on the day of admission,and the blood clot was washed out with bronchoscopy.The vital signs gradually improved after the surgery,however,this patient underwent another interventional embolization because of the recurrence of massive hemoptysis 18 days later.Conclusions Massive hemoptysis is often life-threatening with complex etiology and high mortality.It is necessary to perform hemostasis treatment in a short time to improve respiratory failure.Through the analysis of the diagnosis and treatment process of this case,we aim to give an insight on the treatment of massive hemoptysis for cliniacians.

关 键 词：体外膜肺氧合 支气管动脉-肺动脉瘘 大咯血 

分 类 号：R459.7[医药卫生—急诊医学]