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

A Respiratory Care Experience of Early Lung Recruitment Maneuver in Serotonin Syndrome with Early Stage Acute Respiratory Distress Syndrome

許雅茹(Ya-Ju Hsu) ； 趙克耘(Ke-Yun Chao) ； 劉偉倫(Wei-Lun Liu) ； 曾淇瑋(Chi-Wei Tseng)

《呼吸治療》 20卷1期 (2021/01) Pp. 53-63

https://doi.org/10.6269/JRT.202101_20(1).0006

摘要

血清素是一種肺血管收縮劑，血清素症候群嚴重者會引起瀰漫性血管內凝血功能異常及急性呼吸窘迫症候群。急性呼吸窘迫症候群（Acute Respiratory Distress Syndrome, ARDS）是一種具有高死亡率的重症疾病。臨床特徵為嚴重低血氧、肺部順應性降低及雙側肺浸潤，目前醫學證據支持的呼吸治療方式為肺保護策略合併最佳吐氣末正壓使用。2013年的文獻指出ARDS早期介入俯臥式通氣能顯著改善死亡率。肺泡回復術能改善氧合、功能肺餘容量同時減少不穩定的肺泡重覆開合而導致加重呼吸器引起肺損傷問題，然而對於介入肺泡復張術的時機點仍尚未有定論。本文分享一位血清素症候群病人合併ARDS早期介入肺泡回復術而成功改善個案肺生理狀態、成功脫離呼吸器並存活之相關經驗。

關鍵字

血清素症候群 ； 急性呼吸窘迫症候群 ； 肺泡回復術

並列摘要

Serotonin syndrome is a vasoconstriction resulting in disseminated intravascular coagulation and acute respiratory distress syndrome (ARDS). ARDS is a life-threatening condition associated with severe hypoxemic, decreased lung compliance, and bilateral lung infiltration. Lung protective strategy combined with optimum positive end-expiratory pressure for ARDS is a supported by evidence. Lung recruitment maneuver improved oxygenation, functional residual capacity, and prevented from ventilator-induced lung injury. Previous report in 2013 indicated early prone ventilation significantly decreased the mortality rate in early stage of ARDS. However, what is the best time point of early lung recruitment maneuver in ARDS the remains unknown. In this case presentation, we share an experience in improved pulmonary physiology outcomes and weaning from mechanical ventilation through the early lung recruitment maneuver in early stage of ARDS.

並列關鍵字

serotonin syndrome ； acute respiratory distress syndrome ； lung recruitment maneuver