Wang Hong-Yu, Li Yi-Hao, Zhang Si-Sen, Jiang Xin, Niu Xing-Guo, Qian Xin-Ling, Liu Cong-Yan
Department of Emergency Medicine, The Fifth Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, China.
Department of Emergency Intensive Care Unit, People's Hospital of Henan University of Chinese Medicine/Zhengzhou People's Hospital, Zhengzhou, China.
Front Physiol. 2022 Jun 29;13:902465. doi: 10.3389/fphys.2022.902465. eCollection 2022.
To investigate the application effect of extracorporeal membrane oxygenation (ECMO) in patients with severe acute respiratory distress syndrome (ARDS) caused by pneumonia (PJP) after kidney transplantation. This is a case series on 10 kidney transplant recipients with severe ARDS caused by PJP at the People's Hospital of Zhengzhou, who were enrolled as the case group. A total of 17 cases of PJP diagnosed with severe ARDS without ECMO were selected as the control group. The timing and mode of ECMO support and treatment complications were summarized. The primary aim of this study was mortality and secondary was imaging and complications. The enrolled patients' oxygenation index before the start of ECMO ranged from 25 to 92, and the time from admission to the start of ECMO was 1-17 days, with an average of 5.56 days. In the case group, one patient died of hemorrhagic shock due to abdominal hemorrhage, but the other nine patients were successfully weaned from ECMO. Of these patients, one died due to sepsis following weaning. The survival rate in the case group was 80.0% (8/10), and the survival rate in the control group was 35.29% (6/17). The vein-vein ECMO support time in the nine successfully weaned patients in the case group ranged from 131 to 288 h, with an average of 215.5 h. Of the eight patients who survived, deterioration of renal function after transplantation occurred in two patients, but no fatal complications occurred. Overall, Patients with severe ARDS caused by postoperative PJP infection following kidney transplantation have a poor prognosis. The mortality was lower in patients who were treated with ECMO compared to standard care.
探讨体外膜肺氧合（ECMO）在肾移植术后肺炎（PJP）所致严重急性呼吸窘迫综合征（ARDS）患者中的应用效果。这是一项关于郑州人民医院10例肾移植术后因PJP导致严重ARDS患者的病例系列研究，这些患者被纳入病例组。选取17例诊断为严重ARDS且未使用ECMO的PJP患者作为对照组。总结了ECMO支持的时机、模式及治疗并发症。本研究的主要目的是死亡率，次要目的是影像学表现和并发症。纳入患者在开始ECMO治疗前的氧合指数为25至92，从入院到开始ECMO治疗的时间为1至17天，平均为5.56天。病例组中，1例患者因腹腔出血死于失血性休克，但其他9例患者成功撤机。其中，1例患者撤机后死于脓毒症。病例组的生存率为80.0%（8/10），对照组的生存率为35.29%（6/17）。病例组9例成功撤机患者的静脉 - 静脉ECMO支持时间为131至288小时，平均为215.5小时。8例存活患者中，2例出现移植后肾功能恶化，但未发生致命并发症。总体而言，肾移植术后PJP感染所致严重ARDS患者预后较差。与标准治疗相比，接受ECMO治疗的患者死亡率较低。
