体外膜肺氧合治疗特发性肺含铁血黄素沉着症所致弥漫性肺泡出血：一例报告及文献复习
Extracorporeal Membrane Oxygenation for Diffuse Alveolar Hemorrhage Caused by Idiopathic Pulmonary Hemosiderosis: A Case Report and a Review of the Literature.
作者信息
Matsumoto Shotaro, Nakagawa Satoshi
机构信息
Division of Critical Care Medicine, National Center for Child Health and Development, Setagaya, Tokyo, Japan.
出版信息
J Pediatr Intensive Care. 2019 Sep;8(3):181-186. doi: 10.1055/s-0039-1679904. Epub 2019 Feb 25.
Abstract
Diffuse alveolar hemorrhage (DAH) is a life-threatening condition presenting with hemoptysis, anemia, and diffuse radiographic pulmonary infiltrates; it causes acute respiratory failure. Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of DAH occurring predominantly in children. Bleeding is often considered to be a contraindication for extracorporeal membrane oxygenation (ECMO) due to systemic anticoagulation. We present an 8-year-old girl with DAH caused by IPH. Unfractionated heparin was administered to maintain an activated clotting time of 150 to 180 seconds. The DAH resolved with immunosuppressive therapy, and the patient survived to decannulation. ECMO may be applied as a rescue therapy for DAH even with systemic anticoagulation.
摘要
弥漫性肺泡出血（DAH）是一种危及生命的疾病，表现为咯血、贫血和弥漫性肺部影像学浸润；它会导致急性呼吸衰竭。特发性肺含铁血黄素沉着症（IPH）是DAH的一种罕见病因，主要发生于儿童。由于全身抗凝，出血常被视为体外膜肺氧合（ECMO）的禁忌证。我们报告一名8岁患特发性肺含铁血黄素沉着症导致弥漫性肺泡出血的女孩。给予普通肝素以维持活化凝血时间在150至180秒。弥漫性肺泡出血通过免疫抑制治疗得到缓解，患者存活至撤机。即使存在全身抗凝，ECMO也可作为弥漫性肺泡出血的一种挽救治疗方法。
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