连续肾脏替代疗法和体外膜氧合技术序贯高压氧治疗减压病继发多器官功能衰竭一例

A case of decompression sickness complicated with multiple organ failure treated by hyperbaric oxygen therapy sequential with continuous renal replacement therapy and extracorporeal membrane oxygenation

目的探讨生命体征不稳的Ⅱ型减压病患者就地加压治疗及多学科诊疗(MDT)救治新思路,为危重症减压病患者就近救治提供借鉴。方法对2020年1月某三甲综合医院诊治的Ⅱ型减压病并发多器官功能障碍综合征(MODS)患者多学科协作救治的临床资料进行分析总结。结果患者潜水放漂出水3 min后出现意识障碍、休克,CT检查显示全身多器官静脉系统积气,实验室检查结果提示MODS。给予患者0.12~0.18 MPa加压治疗吸氧方案,氧舱内静脉补液8900 ml,总治疗时间为9 h 45 min。出舱时患者昏迷,CT复查证实静脉气泡消除,实验室检查提示多器官功能衰竭(MOF),给予机械辅助呼吸、连续肾脏替代疗法(CRRT)和体外膜肺氧合(ECMO)等综合支持治疗,患者住院32 d后康复出院。结论生命体征不稳定的危重症减压病患者就近送至当地拥有空气加压氧舱、重症医学科的综合医院,组织潜水医学、高压氧医学和重症医学人员MDT可实现成功救治。

Objective To discuss the new idea of on-the-spot recompression treatment and multidisciplinary treatment(MDT)for patients with unstable vital signs of type II decompression sickness.To provide reference for the nearby treatment of patients with critical decompression sickness.Methods The clinical data of a case of a multi-disciplinary collaborative treatment of type II decompression sickness complicated with multiple organ dysfunction syndrome(MODS)admitted to a third-class A hospital in January 2020 were analyzed and summarized.Results The patient suffered from consciousness disturbance and shock after 3 min of diver's blow-up out of the water.CT examination showed gas accumulation in the systemic multi-organ venous system,and laboratory examination suggested MODS.The oxygen inhalation regimen was given in the session of recompression treatmen by 0.12-0.18 MPa.Intravenous fluid was the total of 8900 ml in the session,and the total recompression treatment time was 9 h 45 min.The patient was still in unconscious when he finished the session.CT re-examination confirmed the elimination of venous bubbles,and laboratory examination indicated multiple organ failure(MOF).The patient was given comprehensive supporting treatment by mechanical assisted breathing and following by continuons renal replacement therapy(CRRT)and extrocorporeal membrane oxygenation(ECMO)in the intensive care unit,and was discharged after 32 d of hospitalization.Conclusion Critical decompression sickness patients with unstable vital signs are taken to a local general hospital with hyperbaric oxygen chamber and intensive care unit.The successful treatment can be achieved by organizing diving medicine,hyperbaric oxygen medicine and critical medical personnel for MDT.