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成功使用体外膜肺氧合和连续肾脏替代疗法联合治疗尿脓毒症患者:病例报告及文献复习。

Successful cure of a patient with urosepsis using a combination of extracorporeal membrane oxygenation and continuous renal replacement therapy: A case report and literature review.

机构信息

Department of Critical Care Medicine, The First Affiliated Hospital of USTC, Hefei 230032, China.

Department of Critical Care Medicine, The First Affiliated Hospital of USTC, Hefei 230032, China.

出版信息

Chin J Traumatol. 2020 Dec;23(6):372-375. doi: 10.1016/j.cjtee.2020.09.006. Epub 2020 Sep 21.

Abstract

Holmium laser lithotripsy (HLL) is one of the common surgical methods for urolithiasis. It causes minor surgical trauma, but complications are not rare. Extracorporeal membrane oxygenation (ECMO) treatment of sepsis is common, but venoarterial (VA)-ECMO treatment of urosepsis has not been reported yet. In this article, we reported a 67-year-old female patient with refractory septic shock caused by HLL under percutaneous nephroscope, involving breathing, heart, kidney and other organs, and organs support treatment was ineffective for the patient. Finally, we successfully treated the patient under VA-ECMO with continuous renal replacement therapy (CRRT). Combined ECMO and CRRT may provide a solution for addressing refractory sepsis. Here we present the case and review relevant literature, so as to provide a treatment strategy for patients with refractory urogenic sepsis and to reduce the mortality rate.

摘要

钬激光碎石术(HLL)是治疗尿路结石的常用手术方法之一。它造成的手术创伤较小,但并不罕见会出现并发症。体外膜肺氧合(ECMO)治疗败血症很常见,但静脉-动脉(VA)-ECMO 治疗尿路败血症尚未见报道。本文报道了一例 67 岁女性患者,因经皮肾镜下 HLL 导致难治性感染性休克,累及呼吸、心脏、肾脏等多器官,器官支持治疗对患者无效。最终,我们成功地为患者进行了 VA-ECMO 联合连续肾脏替代治疗(CRRT)。ECMO 和 CRRT 的联合应用可能为治疗难治性败血症提供了一种解决方案。本文报道了该病例并复习了相关文献,为治疗难治性尿源性败血症患者提供了一种治疗策略,降低了死亡率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c8b8/7718516/9dcf0cb89627/gr1.jpg

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