体外膜肺氧合支持救治成人肺出血肾炎综合征一例

王珊; 尹海燕; 主有峰; 陶佩; 张锐; 马永辉; 韦建瑞

doi:10.24920/003478

Your Location：

Home >

Browse articles >

体外膜肺氧合支持救治成人肺出血肾炎综合征一例

中国医学科学杂志（英文版） 2019年34卷第3期页码：226-229

Case Report | Updated：2024-04-10

- 体外膜肺氧合支持救治成人肺出血肾炎综合征一例
- Affiliations：
  
  1. 1 Department of Intensive Care Unit, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou 510220, China
  2. 2 Institute of Clinical Nutrition, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou 510220, China
- Author bio：
  
  *Tel: 86-18928900398, E-mail: jianrui_wei@sina.com
- Funds：
  
  Supported by the Natural Science Foundation of Guangdong Province of China(2015A030313735);the Science and Technology Planning Project of Guangdong Province of China(No. 2014A020212651)
- DOI：10.24920/003478
  中图分类号：
- 收稿日期：2019-06-18，
  
  网络出版日期：2019-06-18，
  
  纸质出版日期：2019-06-18
- Accepted：
Scan QR Code
王珊, 尹海燕, 主有峰, 等. 体外膜肺氧合支持救治成人肺出血肾炎综合征一例[J]. 中国医学科学杂志（英文版）, 2019,34(3):226-229.

Wang Shan, Yin Haiyan, Zhu Youfeng, et al. Management of an Adult with Goodpasture’s Syndrome Following Brain Trauma with Extracorporeal Membrane Oxygenation: A Case Report[J]. Chinese medical sciences journal, 2019, 34(3): 226-229.
王珊, 尹海燕, 主有峰, 等. 体外膜肺氧合支持救治成人肺出血肾炎综合征一例[J]. 中国医学科学杂志（英文版）, 2019,34(3):226-229. DOI： 10.24920/003478.

Wang Shan, Yin Haiyan, Zhu Youfeng, et al. Management of an Adult with Goodpasture’s Syndrome Following Brain Trauma with Extracorporeal Membrane Oxygenation: A Case Report[J]. Chinese medical sciences journal, 2019, 34(3): 226-229. DOI： 10.24920/003478.

摘要

患者男

22岁

因“跌倒致头晕、呕吐1天”入院

入院后第3天突发呼吸困难、低血氧

气管插管过程中见气道内弥漫性出血

呼吸机辅助通气难以纠正低氧血症。经股静脉-股动脉安置体外膜肺氧合（ECMO）后

患者的血氧饱和度得到明显改善。同时患者的肾功能急剧恶化

立即行持续性肾脏替代治疗（CRRT）后

患者的肾功能仍进行性恶化。尽管在患者的血清中未检测到抗肾小球基底膜抗体

但结合患者症状、体征及相关实验室检查

经过全院会诊讨论考虑为Goodpasture综合征。经过3天的激素冲击和血浆置换治疗后

患者的肾功能得到明显改善。最终顺利拔管出院。

Abstract

A 22-year-old man suffered from acute pulmonary hemorrhage and deteriorated renal function occurred within 3 days after traumatic brain injury. Mechanical ventilation cannot correct his severe hypoxemia

therefore

venoarterial extracorporeal membrane oxygenation (VA-ECMO) support was initiated and finally resolved his hypoxemia. Concomitantly

continuous renal replacement therapy was performed to improve his kidney function. Although no anti-glomerular basement membrane (anti-GBM) antibody was detected in serum

Goodpasture’s syndrome was considered. After treated with methylprednisolone pulse therapy and plasmapheresis

his renal function was significantly improved. ECMO was eventually discontinued after 60 hours of treatment and extubated on day 10. He was discharged home with normal pulmonary and renal functions.

关键词

Keywords

references

Hellmark T , Segelmark M . Diagnosis and classification of Goodpasture’s disease (anti-GBM) . J Autoimmun 2014 ; 48-9 : 108 - 12 . doi: 10.1016/j.jaut.2014.01.024 10.1016/j.jaut.2014.01.024 .

Lahmer T , Heemann U . Anti-glomerular basement membrane antibody disease: a rare autoimmune disorder affecting the kidney and the lung . Autoimmun Rev 2012 ; 12 ( 2 ): 169 - 73 . doi: 10.1016/j.autrev.2012.04.002 10.1016/j.autrev.2012.04.002 . DOI: 10.1016/j.autrev.2012.04.002 http://doi.org/10.1016/j.autrev.2012.04.002

Ohlsson S , Herlitz H , Lundberg S , et al . Circulating anti-glomerular basement membrane antibodies with predominance of subclass IgG4 and false-negative immunoassay test results in anti-glomerular basement membrane disease . Am J Kidney Dis 2014 ; 63 ( 2 ): 289 - 93 . doi: 10.1053/j.ajkd.2013.08.032 10.1053/j.ajkd.2013.08.032 . DOI: 10.1053/j.ajkd.2013.08.032 http://doi.org/10.1053/j.ajkd.2013.08.032

Levy JB , Turner AN , Rees AJ , et al . Long-term outcome of anti-glomerular basement membrane antibody disease treated with plasma exchange and immunosuppression . Ann Intern Med 2001 ; 134 ( 11 ): 1033 - 42 . doi: 10.7326/0003-4819-134-11-200106050-00009 10.7326/0003-4819-134-11-200106050-00009 .

Napp LC , Kuhn C , Hoeper MM , et al . Cannulation strategies for percutaneous extracorporeal membrane oxygenation in adults . Clin Res Cardiol 2016 ; 105 ( 4 ): 283 - 96 . doi: 10.1007/s00392-015-0941-1 10.1007/s00392-015-0941-1 .

Balke L , Both M , Arlt A , et al . Severe adult respiratory distress syndrome from Goodpasture syndrome. Survival using extracorporeal membrane oxygenation . Am J Respir Crit Care Med 2015 ; 191 ( 2 ): 228 - 9 . doi: 10.1164/rccm.201409-1625IM 10.1164/rccm.201409-1625IM .

Dalabih A , Pietsch J , Jabs K , et al . Extracorporeal membrane oxygenation as a platform for recovery: a case report of a child with pulmonary hemorrhage, refractory hypoxemic respiratory failure, and new onset Goodpasture syndrome . J Extra Corpor Technol 2012 ; 44 ( 2 ): 75 - 7 .

Herbert DG , Buscher H , Nair P . Prolonged venovenous extracorporeal membrane oxygenation without anticoagulation: a case of Goodpasture syndrome-related pulmonary haemorrhage . Crit Care Resusc 2014 ; 16 ( 1 ): 69 - 72 .

浏览量

343

Downloads

CSCD

文章被引用时，请邮件提醒。

Submit

关联资源

暂无数据