H1N1重症患者併發心肺肝腎四器官衰竭接受體外膜氧合、俯臥及肺保護性呼吸器策略：成功病例報告

此個案爲一位33歲男性，經疾病管制局確診之H1N1患者。有第二型糖尿病之病史，主訴發燒、咳嗽伴有血絲的黃色痰液，寒顫並自覺全身無力。症狀持續4天未改善，胸部X光檢查出現兩側瀰漫性浸潤。流感快篩A型陽性，臨床診斷爲H1N1感染併發急性呼吸窘迫症候群(ARDS)。呼吸器調整遵循高PEEP、低潮氣容積之肺保護策略原則，在治療上即時投予抗病毒，抗發炎類固醇及活化蛋白C等藥物，但臨床仍持續惡化出現嚴重低血氧、心因性休克與急性腎衰竭，肝指數也竄升達四器官功能衰竭。在住院48小時內即時使用體外膜氧合(ECMO)，支持心肺功能適時改善嚴重低血氧，爲病患爭取更多的治療時閒，個案也避免了早期快速死亡。而此個案所接受的呼吸器「肺保護性策略」及適時的俯臥治療，有效避免高濃度氧氣與呼吸器可能造成的肺損傷。是此個案終究能順利脫離ECMO與呼吸器的關鍵因素。及時「體外膜氧合」、適時「俯臥」及堅持「肺保護性呼吸器策略」是成功拯救此病人生命的三大關鍵所在。

關鍵字

新流感；急性呼吸窘迫症候群；體外膜氧合；肺保護性策略；俯臥

並列摘要

We report a 33-year-old man with pandemic H1N1 influenza with acute respiratory distress syndrome (ARDS). During the first two-day hospitalization, the patient rapidly developed four-organ (heart, lung, kidney and liver) failure, even though we administered aggressive treatment, such as antiviral medication, corticosteroids, activated protein C, continuous venous-venous hemofiltration (CVVH) and mechanical ventilator support with a lung protective strategy. We treated the patient with ECMO for cardiopulmonary rescue support. The patient was successfully weaned from ECMO ten days later, but his ARDS condition showed poor improvement. We continued with the lung protective ventilator strategy that had been used since the beginning of ventilator use. In addition, 3-5 days of rescue therapy using prone positioning was given four times as the lung condition worsened. The patient was finally weaned from the ventilator on the 55th day of hospitalization. In conclusion, the patient would have expired without ECMO rescue therapy; the lung protective ventilator strategy had a pivotal role in ARDS treatment. The successful weaning from ECMO and the good response to prone positioning were based on the lung protective ventilator strategy, which avoided ventilator-induced lung injury (VILI) and secondary multiple organ failure. ECMO, prone positioning and a lung protective strategy were indispensable in saving the patient's life.

並列關鍵字

Pandemic H1N1 influenza ； Acute respiratory distress syndrome ； ECMO ； Lung protective strategy ； Prone positioning

被引用紀錄

黃憶環、許桂菱、戴雪萍（2017）。運用肺部復健於一位A型流感重症個案脫離呼吸器的照護經驗。榮總護理，34(1)，21-28。https://doi.org/10.6142/VGHN.34.1.21

延伸閱讀

Chen, Y. T., Hsu, C. W., Wu, G. S., & Lai, R. S. (2013). 流感病毒性肺炎引起嚴重急性呼吸窘迫症候群病患使用體外循環維生系統支持治療之效果. 胸腔醫學, 28(4), 200-208. https://www.airitilibrary.com/Article/Detail?DocID=10239855-201308-201307190051-201307190051-200-208
林采榆、柯信國（2022）。胸腔病例（三八四）新型冠狀病毒肺炎（COVID-19）重症照護及呼吸器脫離。臨床醫學月刊，89(1)，59-63。https://doi.org/10.6666/ClinMed.202201_89(1).0011
周騰慶、羅乾鳴、王逸熙、劉婷婷、張惠娟（2023）。一位守宮木導致閉塞性細支氣管炎患者肺移植手術後呼吸治療及照護經驗：病例報告。呼吸治療，22(1)，49-64。https://doi.org/10.6269/JRT.202301_22(1).0005
許雅茹、趙克耘、劉偉倫、曾淇瑋（2021）。一位血清素症候群病人合併急性呼吸窘迫症候群早期介入肺泡復張術之呼吸照護經驗。呼吸治療，20(1)，53-63。https://doi.org/10.6269/JRT.202101_20(1).0006
Fu, C. J., Chen, H. W., Lin, T. Y., Wong, Y. C., Wang, L. J., Wan, Y. L., Wang, C. R., Chen, C. C., Huang, C. G., Ku, Y. K., & Chen, H. W. (2011). Clinical Course and Computed Tomography Abnormalities Associated without and with Concomitant Infection in Patients with Pandemic Influenza A (H1N1) 2009 Virus Infection. Journal of Radiological Science, 36(1), 11-21. https://doi.org/10.6698/JRS.201103_3601.02

國際替代計量

H1N1重症患者併發心肺肝腎四器官衰竭接受體外膜氧合、俯臥及肺保護性呼吸器策略：成功病例報告

全文下載

主題瀏覽