免疫球蛋白联合依库珠单抗治疗GBS并发重度ARDS患者一例  

A case of severe acute respiratory distress syndrome complicated by Guillain-Barrésyndrome treated with immunoglobulin combined with Eculizumab

作　　者：杨东星[1] 沈鹏[2] 赵慧颖[2] Yang Dongxing;Shen Peng;Zhao Huiying(Department of Critical Care Medicine,Cangzhou Combined Hospital of Traditional Chinese and Western Medicine,Cangzhou 061100,China;Department of Critical Care Medicine,People’s Hospital of Peking University,Beijing 100044,China)

机构地区：[1]河北省沧州中西医结合医院重症医学科,河北沧州061100 [2]北京大学人民医院ICU,北京100044

出　　处：《中华重症医学电子杂志》2024年第4期404-408,共5页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.2022-2-34)

摘　　要：吉兰-巴雷综合征(GBS)是一类免疫介导的急性炎性周围神经病,临床特征为急性起病。本例患者发病2周前出现发热、咳嗽上呼吸道感染症状后逐渐出现肢体远端感觉异常、双下肢迟缓性肌无力,患者脑脊液常规、生化检查显示细胞-蛋白分离现象,病情进展迅速累及呼吸肌,造成呼吸衰竭、低氧血症,给予机械通气,患者胸部CT示双肺弥漫性炎性渗出病变,符合GBS并发重症急性呼吸窘迫综合征(ARDS)的诊断,患者于外院早期应用了免疫球蛋白及血浆置换治疗,但效果差,病情仍迅速恶化,出现呼吸衰竭、ARDS症状。入我院后继续应用免疫球蛋白联合依库珠单抗治疗,患者病情得到有效控制,肌力迅速恢复,呼吸功能、氧合指数逐步改善,顺利脱离机械通气支持。Guillain-Barrésyndrome(GBS)is an immune-mediated acute inflammatory polyneuropathy,characterized by its acute onset.This patient presented with symptoms of fever and cough following an upper respiratory tract infection two weeks before the onset of the disease,which gradually progressed to sensory disturbances in the distal extremities and flaccid weakness in the lower limbs.Routine cerebrospinal fluid(CSF)analysis and biochemical tests revealed the phenomenon of cytoalbuminological dissociation.The condition rapidly evolved to involve the respiratory muscles,leading to respiratory failure and hypoxemia,necessitating mechanical ventilation.CT scan of the patient’s chest demonstrated diffuse alveolar infiltrates,consistent with a diagnosis of GBS complicated by severe acute respiratory distress syndrome(ARDS).Despite early treatment with intravenous immunoglobulin and plasmapheresis at another facility with suboptimal outcomes and rapidly deteriorating condition,manifesting respiratory failure and symptoms of ARDS,in this case,we continued treatment with intravenous immunoglobulin in conjunction with Eculizumab.This approach effectively controlled the ARDS,led to a swift recovery of muscle strength,and progressively improved respiratory function and oxygenation indices,ultimately allowing for the successful weaning from mechanical ventilation support.

关 键 词：吉兰-巴雷综合征 依库珠单抗 病毒性肺炎 急性呼吸窘迫综合征 

分 类 号：R746.3[医药卫生—神经病学与精神病学] R741[医药卫生—临床医学]