体外膜肺氧合在危重症鹦鹉热衣原体肺炎患者抢救中的应用

Application of extracorporeal membrane oxygenation in the rescue of critically ill patients with Chlamydia psittaci pneumonia

目的探讨体外膜肺氧合(ECMO)在危重症鹦鹉热衣原体肺炎患者抢救中的安全性和有效性。方法本研究纳入的患者为2018年2月至2022年2月在南京鼓楼医院急诊科就诊并接受ECMO支持治疗的危重症鹦鹉热衣原体肺炎患者4例。收集患者的基本信息和临床资料进行分析。结果3例男性,1例女性,平均年龄61岁,均有鸟类或家禽密切接触史。收集患者的肺泡灌洗液,经宏基因组二代测序(mNGS)测定,确诊鹦鹉热衣原体感染。患者均有发热、进行性呼吸困难和血压下降;实验室检查提示明显的炎症反应,胸部影像显示病变累及多个肺叶,并伴有不同程度的肺外器官功能障碍。4例均符合ECMO应用的适应证,通过人工心肺功能支持和适当的药物应用后,患者肺部炎症逐渐吸收,肺外器官功能逐步恢复。结论ECMO在危重症鹦鹉热衣原体肺炎患者的抢救治疗中是安全和有效的。ECMO在治疗不典型病原体感染引起的多器官功能障碍中的作用值得关注。

Objective To explore the safety and effectiveness of extracorporeal membrane oxygenation(ECMO)in the rescue of critically ill patients with Chlamydia psittaci pneumonia.Methods The patients included in this study were 4 patients with critical Chlamydia psittaci pneumonia who received ECMO support treatment in the Emergency Department of Drum Tower Hospital from February 2018 to February 2022.General information and clinical data were collected and analyzed.Results There were three males and one female,with an average age of 61 years,had a history of close contact with birds or poultry.Metagenomic next-generation sequencing(mNGS)of alveolar lavage fluid was used to confirm Chlamydia psittaci infection.These patients had fever,progressive dyspnea and hypotension at onset.Laboratory examinations showed significant inflammatory reaction.Chest images showed lesions involving multiple lung lobes,accompanied by varying degrees of extrapulmonary organ dysfunction.All the patients met the ECMO application indications.Through artificial cardiopulmonary function support and proper drug application,the patients'lung inflammation was absorbed and the function of extrapulmonary organs was recovered.Conclusion Application of ECMO in the rescue of critically ill patients with Chlamydia psittaci pneumonia is safe and effective.The role of ECMO in the treatment of multiple organ dysfunction caused by atypical pathogen infection deserves attention.