Omote Norihito, Kondoh Yasuhiro, Taniguchi Hiroyuki, Kimura Tomoki, Kataoka Kensuke, Hasegawa Ryuichi, Hasegawa Yoshinori
Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan; Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan.
Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan.
Respir Med Case Rep. 2016 Jun 10;19:31-3. doi: 10.1016/j.rmcr.2016.06.001. eCollection 2016.
Mortality in patients with pulmonary tuberculosis remains high, especially in those who develop acute respiratory distress syndrome (ARDS). We report on a-48-year-old man with ARDS due to severe pulmonary tuberculosis who was rescued by extracorporeal membrane oxygenation (ECMO). He was initially hospitalized in the intensive care unit and noninvasive positive-pressure ventilation started. He was also administered anti-tuberculosis drugs and received systemic corticosteroid therapy. Six days later, further deterioration of gas exchange prompted the decision to intubate. However, he experienced progressive deterioration of arterial oxygenation despite conventional ventilatory support. We therefore decided to administer ECMO on day 9. After initiation of these treatments and ECMO support, pulmonary infiltrate and oxygenation status gradually improved and ECMO was discontinued on day 52. The patient was finally discharged from our hospital without severe disability. ECMO should be considered one of the treatment options for the management of ARDS due to severe pulmonary tuberculosis.
肺结核患者的死亡率仍然很高，尤其是那些并发急性呼吸窘迫综合征（ARDS）的患者。我们报告了一名48岁因严重肺结核导致ARDS的男性患者，他通过体外膜肺氧合（ECMO）获救。他最初入住重症监护病房并开始无创正压通气。他还接受了抗结核药物治疗并接受了全身糖皮质激素治疗。六天后，气体交换进一步恶化促使决定进行气管插管。然而，尽管给予了传统通气支持，他的动脉氧合仍逐渐恶化。因此，我们在第9天决定给予ECMO治疗。在开始这些治疗和ECMO支持后，肺部浸润和氧合状态逐渐改善，ECMO于第52天停用。患者最终从我院出院，无严重残疾。ECMO应被视为严重肺结核所致ARDS治疗的选择之一。
