吸入性损伤致重度急性呼吸窘迫综合征1例  

A case of severe acute respiratory distress syndrome caused by inhalation injury

作　　者：顾彩虹[1] 李小民[1] 康秀文[1] Gu Caihong;Li Xiaomin;Kang Xiuwen(Department of Critical Care Medicine,the First People's Hospital of Lianyungang City,Lianyungang 222002,China)

机构地区：[1]连云港市第一人民医院重症医学科,连云港222002

出　　处：《中华烧伤与创面修复杂志》2023年第12期1185-1189,共5页Chinese Journal of Burns And Wounds

基　　金：江苏省科技厅社会发展面上项目(BE2020670)。

摘　　要：2022年6月26日,连云港市第一人民医院收治1例吸入性损伤致重度急性呼吸窘迫综合征的54岁男性患者。患者入院后即接受了有创机械通气(驱动压导向的呼吸机参数设置)联合俯卧位治疗,但其病情持续恶化。入院5 h后,患者接受了静脉-静脉体外膜氧合(VV-ECMO)支持治疗、基于肺超保护性通气策略的治疗联合每日>12 h的俯卧位通气治疗,同时经脉搏轮廓心输出量监测技术监测心脏指数及血管外肺水指数等情况以指导容量管理,并行多次纤维支气管镜肺泡灌洗治疗,后成功撤离VV-ECMO及呼吸机并顺利康复出院。伤后随访1年,患者无明显呼吸道症状,肺功能基本正常。A 54-year-old male patient with severe acute respiratory distress syndrome caused by inhalation injury was admitted to the First People's Hospital of Lianyungang City on June 26th,2022.After admission,the patient received invasive mechanical ventilation(driving pressure-guided ventilator parameter setting)combined with prone position treatment immediately,but his condition continued to deteriorate.Five hours after admission,the patient received veno-venous extracorporeal membrane oxygenation(VV-ECMO)supporting treatment,treatment based on ultra-protective lung ventilation strategy combined with prone position ventilation for more than 12 hours per day.At the same time,pulse contour cardiac output monitoring technology was used to monitor cardiac index and extravascular lung water index to guide volume management,and fiberoptic bronchoalveolar lavage was performed for several times.After that,the patient was successfully weaned from VV-ECMO and ventilator,and then discharged from hospital successfully.During follow-up of one year after the injury,the patient showed no obvious respiratory symptoms,and his lung function was basically normal.

关 键 词：烧伤 吸入性 体外膜氧合作用 急性呼吸窘迫综合征 肺超保护性通气策略 

分 类 号：R563.8[医药卫生—呼吸系统]