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重症小儿支原体肺炎导致弥漫性肺泡出血需行静脉-静脉体外膜肺氧合:一例报告

Severe pediatric Mycoplasma pneumonia as the cause of diffuse alveolar hemorrhage requiring veno-venous extracorporeal membrane oxygenation: A case report.

作者信息

Zhang Xinjuan, Yu Yanping

机构信息

Department of Pediatric Intensive Care Unit, Affiliated to Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.

出版信息

Front Pediatr. 2023 Jan 6;10:925655. doi: 10.3389/fped.2022.925655. eCollection 2022.

Abstract

BACKGROUND

Diffuse alveolar hemorrhage (DAH) is an acute life-threatening disease often associated with immunocompromised patients and systemic disorders, such as infections, vasculitis, and toxins. is one of the most common causes of community-acquired pneumonia in children, which rarely causes respiratory failure and fulminant disease; However, a rapid progression may occur in some patients. Mycoplasma pneumonia-associated DAH is rare.

CASE PRESENTATION

We report a case of severe pediatric mycoplasma pneumonia in an immuno-competent child. This patient's condition progressed rapidly, with severe lung lesions associated with pleural effusion, coagulopathy, diffuse alveolar haemorrhage and severe respiratory distress requiring ventilator and intravenous extracorporeal membrane oxygenation (VV-ECMO) support. She was discharged upon successful treatment.

CONCLUSION

Diffuse alveolar hemorrhage associated with in children is very rare, and clinicians should be aware of the potential rapid onset of the disease. Early detection and diagnosis are very important. The main treatment measures include anti-infection and supportive measures such as mechanical ventilation, but as in our case, success with both prone positioning for more than 10 h per day and VV-ECMO was life-saving.

摘要

背景

弥漫性肺泡出血(DAH)是一种急性危及生命的疾病,常与免疫功能低下患者及全身疾病相关,如感染、血管炎和毒素。是儿童社区获得性肺炎最常见的病因之一,很少导致呼吸衰竭和暴发性疾病;然而,部分患者可能会迅速进展。支原体肺炎相关的DAH较为罕见。

病例报告

我们报告一例免疫功能正常儿童的重症支原体肺炎病例。该患者病情迅速进展,伴有严重肺部病变及胸腔积液、凝血病、弥漫性肺泡出血,严重呼吸窘迫需要呼吸机及静脉-静脉体外膜肺氧合(VV-ECMO)支持。经成功治疗后出院。

结论

儿童支原体肺炎相关的弥漫性肺泡出血非常罕见,临床医生应意识到该病可能迅速起病。早期发现和诊断非常重要。主要治疗措施包括抗感染及机械通气等支持措施,但如我们的病例所示,每天俯卧位超过10小时及VV-ECMO成功应用挽救了生命。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/31d7/9858565/6fbdd03fb763/fped-10-925655-g001.jpg

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