Experience Using ECMO in Patients with H1N1-associated ARDS: Two Case Reports and Review of the Literature

體外膜氧合治療使用於兩位H1N1新型流感相關之急性呼吸窘迫症候群病患之臨床經驗：病例報告與文獻回顧

白雪芬(Hseuh-Fen Bai) ； 葉育雯(Diana Yu-Wung Yeh) ； 林鎮均(Chen-Chun Lin)

《胸腔醫學》 26卷5期 (2011/10) Pp. 281-287

https://doi.org/10.29806/TM.201110.0006

摘要

H1N1是一種新型流感病毒，曾於墨西哥引起大規模的社區流行。其症狀可以從輕微的自限性疾病到嚴重的急性呼吸道窘迫症候群。我們舉出2例H1N1感染引起的急性呼吸道窘迫症候群，經使用體外膜氧合治療後好轉。第一例是一名52歲患有糖尿病女性，由於發燒、乾咳、呼吸困難一個禮拜而至急診，流感病毒抗原快速檢測為陽性，當天病人就發生急性缺氧性呼吸衰竭並快速進展至急性呼吸道窘迫症候群，由於呼吸器輔助下仍呈現難治性缺氧，第二天開始使用體外膜氧合治療，這位病人在使用呼吸器42天後成功拔管。第二例是50歲患糖尿病女性，由於乾咳及逐漸加重的呼吸困難3天而至急診，流感病毒抗原快速檢測為陽性，當天病情快速進展至急性呼吸道窘迫症候群並使用體外膜氧合治療，病人在使用呼吸器18天後成功拔管。我們的經驗顯示在H1N1感染引起的急性呼吸道窘迫症候群，早期使用體外膜氧合治療可以挽救性命。

關鍵字

體外膜氧合 ； 急性呼吸道窘迫症候群 ； H1N1新型流感

並列摘要

H1N1 is a novel strain of influenza virus, and has caused a large-scale community outbreak of respiratory illnesses in Mexico. The severity of symptoms varies from self-limited disease to acute respiratory distress syndrome (ARDS). Herein, we report 2 patients with severe H1N1 infection-associated ARDS who were successfully treated with extracorporeal membrane oxygenation (ECMO). The 1st patient was a 52-year-old diabetic woman who presented at the emergency department with symptoms of fever, dry cough, and shortness of breath for 1 week. The rapid influenza antigen test was positive. Acute hypoxic respiratory failure developed and progressed to ARDS on the same day of admission. On the 2nd day of admission, venous-venous (V-V) ECMO was instituted for intractable hypoxemia, despite mechanical ventilation and placing the patient in the prone position for maximal recruitment. She was successfully extubated after 42 days of mechanical ventilation. The 2nd case was a 50-year-old diabetic woman who presented at the emergency department with symptoms of dry cough and progressive shortness of breath for 3 days. The rapid influenza antigen test was positive. She developed ARDS rapidly and ECMO was started on the same day of admission. She was successfully extubated after 18 days of mechanical ventilation. Our experience showed that ECMO could be life-saving if initiated early in the course of H1N1 infection-related ARDS.

並列關鍵字

Extracorporeal membrane oxygenation ； H1N1 influenza ； Adult respiratory distress syndrome