除草劑吸入續發性肺泡蛋白沉積症使用葉克膜及全肺灌洗治療：病例報告

Secondary pulmonary alveolar proteinosis with use of ECMO caused by herbicide inhalation: a case report

羅子涵(Tzu-Han Lo) ； 陳慧秦(Hui-Chin Chen) ； 蔡玉琴(Yuh-Chyn Tsai) ； 劉瑞芳(Jui-Fang Liu)

《呼吸治療》 21卷1期 (2022/01) Pp. 75-83

https://doi.org/10.6269/JRT.202201_21(1).0007

摘要

當除草劑吸入造成肺蛋白沉積症極為罕見（＜5%），病因是吸入有害物質巴拉刈（paraquat）抑制了肺泡巨噬細胞分解磷脂及蛋白質，當肺泡堆積過量的磷脂及脂蛋白，會造成肺泡上皮破壞，肺水腫，肺間質發炎或纖維化，進而產生呼吸衰竭的現象。因此，本文特提出一除草劑吸入續發性肺泡蛋白沉積症合併呼吸衰竭使用葉克膜及全肺灌洗治療（whole lung lavage, WLL）的病例報告。病人是一位51歲男性農夫，因吸入巴拉刈除草劑造成嚴重的肺蛋白沉積症，患者曾在家使用居家非侵襲型呼吸器，但因呼吸困難，低血氧，及呼吸衰竭入院插管治療，之後在使用葉克膜下執行雙邊全肺灌洗治療（WLL），因而改善除草劑吸入造成嚴重肺蛋白沉積症之呼吸衰竭症狀，包括胸部X光顯著改善，血氧從88%上升至96%，一氧化碳肺瀰散量（diffusing capacity of the lung for carbon monoxide, DLCO）從27%上升至72%。因此，在臨床上嚴重肺蛋白沉積症合併呼吸衰竭患者，呼吸器單肺通氣設定，有低血氧或血液動力學不穩定的情況，可考慮在使用葉克膜下執行全肺灌洗治療（WLL）是可以改善患者呼吸衰竭的急性情況。

關鍵字

肺蛋白沉著症 ； 全肺灌洗治療 ； 呼吸衰竭 ； 巴拉刈 ； 除草劑

並列摘要

The herbicide is the rare cause of pulmonary alveolar proteinosis (＜5%). The pathogenesis is that the inhalation of toxic variant, paraquat, inhibit the ability of alveolar macrophage to break down phospholipids and proteins. When there are excess phospholipids and proteins accumulate in alveolar, it will cause alveolar epithelium damage, pulmonary edema, interstitial lung inflammation or fibrosis. This will result in respiratory failure. Hence, we present a case report of a person who had pulmonary alveolar proteinosis combined with extracorporeal membrane oxygenation (ECMO) use that is caused by herbicide inhalation. A 51-year-old male farmer suffered from severe pulmonary alveolar proteinosis due to Paraquat herbicide. Patient received non invasive positive pressure ventilator at home. However, due to progressive dyspnea, hypoxemia and respiratory failure, he admitted to intensive care unit with ventilation support after intubation. He received bilateral whole lung lavage under ECMO support. The respiratory failure condition improved after treatment, included chest X-ray improvement, elevated oxygenation from 88% to 96% and increased DLCO from 27% to 72%. Therefore, for severe pulmonary alveolar proteinosis patient with respiratory failure who under one lung ventilation and still suffered from hypoxemia and unstable hemodynamic status. We can consider whole lung lavage under ECMO support to ameliorate patient’s acute respiratory failure status.

並列關鍵字

pulmonary alveolar proteinosis ； whole lung lavage ； respiratory failure ； Paraquat ； herbicide