腸胃道基質腫瘤病患之呼吸照護經驗

Respiratory Care Experience for a Patient with Gastrointestinal Stromal Tumor

許諄諄(Chun-Chun Hsu) ； 黃錦華(Chin-Hua Huang) ； 周蘭娣(Lan-Ti Chou) ； 蕭秀鳳(Hsiu-Feng Hsiao) ； 邊苗瑛(Mauo-Ying Bien)

《呼吸治療》 7卷1期 (2008/01) Pp. 57-67

https://doi.org/10.6269/JRT.2008.7.1.05

摘要

腸胃道基質腫瘤(gastrointestinal stromal tumor, GIST)是一種會危及生命的軟組織肉瘤，由於生長蛋白kit 基因的突變，產生不正常的酪氨酸激酶(tyrosine kinase)且持續作用，刺激細胞不斷生長，產生GIST。此病症以往沒有特殊藥物可以醫治，診斷率偏低，治療效果差。近年來在GIST的診斷及治療上已有重大突破，藥物Glivec的問世，阻斷生長蛋白kit的信號，使癌細胞停止生長，爲目前唯一成功治療GIST的藥物。
本病患就醫時腸胃道基質腫瘤已經過於龐大，引起許多併發症，對於藥物的治療效果不佳，加上接受手術後又產生急性肺損傷，影響肺部通氣和氧合功能而致呼吸衰竭，需插管使用呼吸器，並用連續靜脈血液透析(continuous venous-venous hemodialysis, CVVHD)幫助排除身體過多的水分，但因病患的感染情況未能有效控制，治療近一個月後終告不治。對於此類病患，如何利用機械通氣治療以改善呼吸衰竭是呼吸治療師在照護此病患過程中所要扮演的重要角色，而疾病本身的治療及感染控制方法是提高此類病患預後時所需注意的問題。

關鍵字

腸胃道基質腫瘤 ； 生長蛋白kit ； 輸血導致的急性肺損傷 ； 高頻震盪通氣

並列摘要

Gastrointestinal stromal tumors (GISTs) are mesenchymal neoplasms of the gastrointestinal tract, which is mediated by kit oncogenic signaling mechanisms. Such tumors usually related to activate mutations in kit tyrosine kinases that are continually active in the absence of a normal stimulus, leading to increased cell proliferation. There was no effective treatment and always underdiagnosed in the past. Recently, the use of drug Glivec has been proven effective and increasing survival rate in the treatment of metastatic GISTs. It is the only effective medication in GISTs now.
The patient was diagnosed as GISTs when the tumor was huge with many complications. It was highly resistant to medical therapy. After the patient received surgical resection, he developed acute lung injury which might be related to blood transfusion and resulted in acute respiratory failure. Endotracheal intubation and mechanical ventilation were used to support his respiratory function and continuous venous to venous hemodialysis was applied to excrete excess fluid from the body. Because of the poor control of infection, the patient was expired one month later. In this report, we will discuss the critical role of respiratory therapist in mechanical ventilation strategy to improve the patient's respiratory function. The importance of treating his underlying disease and effective infection control for improving prognosis of GISTs patients were also emphasized.

並列關鍵字

Gastrointestinal stromal tumor GIST ； Kit ； Transfusion-related acute lung injury TRALI ； High frequency oscillatory ventilation HFOV