Matsuo Tomoji, Yanagawa Youichi, Takeuchi Yuji, Inoue Teruhiro, Oomori Kazuhiko, Osaka Hiromichi, Hayashi Nobuhiro, Oode Yasumasa, Shimizu Takashi, Sato Nobuyuki, Okamoto Ken
Department of Acute Critical Care Medicine Shizuoka Hospital, Juntendo University Izunokuni Shizuoka Japan.
Department of Cardiology Shizuoka Hospital, Juntendo University Izunokuni Shizuoka Japan.
Acute Med Surg. 2013 Dec 18;1(2):122-125. doi: 10.1002/ams2.7. eCollection 2014 Apr.
The patient's chart was reviewed, summarized, and presented.
A 41-year-old male collapsed after complaining of dyspnea just before the end of a hemodialysis session. He was just being introduced to hemodialysis. The patient's percutaneous oxygen saturation dropped to 50% even under inhalation of 10 L/minute of oxygen and he developed pulseless electrical activity. After tracheal intubation, a return of spontaneous circulation was noted. His truncal CT disclosed a bilateral diffuse ground glass appearance and pleural effusion were noted. Induced mild hypothermic therapy and mechanical ventilation resulted in the improvement of his respiratory function and consciousness. A coronary angiogram and left ventriculography showed no significant lesion, and his pulmonary edema was considered to have been induced by over-hydration due to renal failure, diastolic heart failure or dialysis disequilibrium syndrome. He was discharged without any neurological deficit.
Tracheal intubation with ventilation for hypoxic cardiopulmonary arrest and induced hypothermic therapy after obtaining spontaneous circulation may be factors of favorable outcome of this case.
对患者病历进行了查阅、总结并汇报。
一名41岁男性在血液透析疗程即将结束前诉说呼吸困难后晕倒。他刚开始接受血液透析治疗。即便在吸入每分钟10升氧气的情况下，患者经皮血氧饱和度仍降至50%，并出现无脉电活动。气管插管后，观察到自主循环恢复。其躯干CT显示双侧弥漫性磨玻璃样表现，并伴有胸腔积液。诱导性轻度低温治疗和机械通气使他的呼吸功能和意识得到改善。冠状动脉造影和左心室造影未显示明显病变，其肺水肿被认为是由肾衰竭、舒张性心力衰竭或透析失衡综合征导致的水合过量引起的。他出院时没有任何神经功能缺损。
对缺氧性心肺骤停进行气管插管通气以及在自主循环恢复后进行诱导性低温治疗可能是该病例取得良好预后的因素。
