青少年百草枯中毒后肺移植1例并文献复习  

Lung transplantation after paraquat poisoning in an adolescent: one case report and literature review

作　　者：孟凡杰 张岩[1] 蔡宏飞 孟凡宇 王瑞[1] 崔有斌[1] 陈静瑜 李洋[1] Meng Fanjie;Zhang Yan;Cai Hongfei;Meng Fanyu;Wang Rui;Cui Youbin;Chen Jingyu;Li Yang(不详;Department of Thoracic Surgery,the First Bethune Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学白求恩第一医院胸外科,长春130021 [2]南京医科大学附属无锡人民医院肺移植中心

出　　处：《器官移植》2024年第1期112-117,共6页Organ Transplantation

基　　金：吉林省重点研发计划项目(JJKH20211163KJ);吉林省市厅局级重点研发计划项目(2021JC013)。

摘　　要：目的总结百草枯中毒患者中毒后移植时机以及相关处理措施对预后的影响。方法回顾性分析1例百草枯中毒行双肺移植术治疗患者的临床资料,总结分析该例患者的临床表现、辅助检查以及诊治经过。结果1例17岁青少年在摄入25%百草枯20~30 mL后出现恶心、呕吐、咳嗽伴全身乏力入院。患者经对症支持治疗后,氧饱和情况无改善,肺部纤维化持续进展,遂在体外膜肺氧合(ECMO)辅助下行序贯双侧肺移植。经术后康复治疗,并积极防治并发症,患者于术后50 d出院。结论百草枯中毒后的移植时机可选择在肝肾功能开始恢复时,围手术期主动、有针对性地预防潜在致病性细菌感染,以及早期康复训练有助于改善肺移植受者的预后。Objective To summarize the effect of the timing of lung transplantation and related treatment measures on clinical prognosis of patients with paraquat poisoning.Methods Clinical data of a patient with paraquat poisoning undergoing bilateral lung transplantation were retrospectively analyzed.Clinical manifestations,auxiliary examination,diagnosis and treatment of this patient were summarized and analyzed.Results A 17-year-old adolescent was admitted to hospital due to nausea,vomiting,cough and systemic fatigue after oral intake of 20-30 mL of 25%paraquat.After symptomatic support treatment,the oxygen saturation was not improved,and pulmonary fibrosis continued to progress.Therefore,sequential bilateral lung transplantation was performed under extracorporeal membrane oxygenation(ECMO).After postoperative rehabilitation and active prevention and treatment for postoperative complications,the patient was discharged at postoperative 50 d.Conclusions The timing of lung transplantation after paraquat poisoning may be selected when the liver and kidney function start to recover.Active and targeted prevention of potential pathogen infection in perioperative period and early rehabilitation training contribute to improving clinical prognosis of lung transplant recipients.

关 键 词：肺移植 百草枯中毒 肺纤维化 呼吸衰竭 体外膜肺氧合 感染 过客淋巴细胞综合征 支气管狭窄 

分 类 号：R617[医药卫生—外科学] R563[医药卫生—临床医学]