体外膜肺氧合治疗重症流感相关肺曲霉病1例并文献复习  

Treatment of severe influenza-associated pulmonary aspergillosis by extracorporeal membrane oxygenation:A case report and literature review

作　　者：罗丹心 谷林 阎锡新[1] Luo Danxin;Gu Lin;Yan Xixin(The First Department of Respiratory and Critical Care Medicine,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院呼吸与危重症医学一科,石家庄050000

出　　处：《国际呼吸杂志》2023年第4期448-453,共6页International Journal of Respiration

基　　金：河北省省级科技计划(22377714D);河北省重点研发计划(20277701D)。

摘　　要：本文报道1例42岁女性患者,主因"间断咳嗽、咳痰,伴进行性加重的呼吸困难"入院,病情进展快,早期行气管插管及体外膜肺氧合(ECMO)支持治疗,乙型流感病毒核酸阳性,多次痰培养及肺泡灌洗液培养检出曲霉菌,支气管镜检查示斑片状絮状物严重阻塞支气管,诊断为流感相关肺曲霉病。积极抗真菌治疗后撤离ECMO,之后再次出现氧合恶化行ECMO置管,最终患者因肺出血死亡。侵袭性肺曲霉病常见于严重免疫功能低下人群。免疫功能正常的人群可因流感病毒感染而继发曲霉菌感染。此类患者临床表现不典型,易误诊及漏诊。ECMO作为终极呼吸支持手段,可为疾病的诊断及治疗争取时间。维持适当范围凝血功能对预防肺出血起积极作用。反复评估肺通气功能与肺顺应性,有助于提高ECMO撤离的成功率。A 42-year-old female patient was admitted to hospital due to intermittent cough with sputum and progressive aggravation of dyspnea.With fast progress of the disease,the patient received tracheal intubation and extracorporeal membrane oxygenation(ECMO)at early period.The patient was diagnosed as influenza-associated pulmonary aspergillosis(IAPA)because of confirmed influenza B infection by nucleic acid testing.Sputum culture showed aspergillus fumigatus in bronchial secretions and bronchoscopy showed patchy flocculent seriously obstructing bronchus,which confirmed the diagnosis of IAPA.After active antifungal therapy,ECMO was weaned,but the oxygenation worsened,then ECMO was performed again.Finally,the patient died of pulmonary hemorrhage.Severely immunocompromised patients are more susceptible to invasive pulmonary aspergillosis,and people with normal immune function may develop aspergillus infection secondary to influenza infection.However,IAPA could be misdiagnosed and underdiagnosed owing to the atypical clinical manifestations.ECMO,as the ultimate respiratory support,can buy time for diagnosis and treatment.Maintaining proper range of coagulation function plays an active role in preventing pulmonary hemorrhage.Repeated assessment of lung ventilation function and lung compliance contributes to improved success rate of ECMO evacuation.

关 键 词：侵袭性肺曲霉病 流感相关肺曲霉病 流感 体外膜肺氧合 

分 类 号：R519[医药卫生—内科学] R511.7[医药卫生—临床医学]