Chengxiang Kong, P. Jin, Chun-yi Liu, Jin-ji Xu, Yong Luo, H. Xie, Gang Zhou
{"title":"Extracorporeal membrane oxygenation in the treatment of severe pertussis in infants: a case report and literature review","authors":"Chengxiang Kong, P. Jin, Chun-yi Liu, Jin-ji Xu, Yong Luo, H. Xie, Gang Zhou","doi":"10.3760/CMA.J.ISSN.1673-4912.2019.11.013","DOIUrl":null,"url":null,"abstract":"目的 \n探讨体外膜肺氧合(extracoporeal membrane oxygenation，ECMO)支持治疗婴儿重症百日咳的有效性。 \n \n \n方法 \n回顾报道2018年深圳市宝安区妇幼保健院PICU收治的1例确诊重症百日咳2月龄患儿接受ECMO治疗情况，文献复习重症百日咳及ECMO治疗现状，结合病例总结ECMO支持治疗重症百日咳的经验。 \n \n \n结果 \n未接种百日咳疫苗的2月龄男婴，接触感染病例后发病，并发高白细胞血症、重症肺炎、百日咳脑病、急性呼吸窘迫综合征、心力衰竭及休克等。常规治疗措施无效，出现顽固性低氧血症、严重二氧化碳潴留、循环功能衰竭等表现，实施VA-ECMO支持治疗，联合\"肺休息\"策略、俯卧位通气、限制性液体管理、肺复张等综合性治疗方案，最终成功救治。 \n \n \n结论 \n动态监测白细胞有助于判断病情及预后。重症百日咳合并高白细胞血症患儿的粒细胞与淋巴细胞比例发生倒置提示病情危重。重症百日咳患儿一旦常规治疗无效，出现继发性器官功能障碍，危及生命时，ECMO不失为\"挽救性\"支持治疗手段。","PeriodicalId":68901,"journal":{"name":"中国小儿急救医学","volume":"26 1","pages":"867-870"},"PeriodicalIF":0.0000,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"中国小儿急救医学","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3760/CMA.J.ISSN.1673-4912.2019.11.013","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Objective To investigate the effectiveness of extracorporeal membrane oxygenation (ECMO) in supporting the treatment of severe pertussis in infants. Method: A retrospective report was conducted on a 2-month-old child diagnosed with severe pertussis who received ECMO treatment at the PICU of Bao'an District Maternal and Child Health Hospital in Shenzhen in 2018. Literature review was conducted on the current status of severe pertussis and ECMO treatment, and the experience of ECMO support treatment for severe pertussis was summarized based on the case. As a result, 2-month-old male infants who were not vaccinated against pertussis developed symptoms after exposure to infected cases, including hyperleukopenia, severe pneumonia, pertussis encephalopathy, acute respiratory distress syndrome, heart failure, and shock. The routine treatment measures were ineffective, and there were stubborn hypoxemia, severe carbon dioxide retention, circulatory failure and other manifestations. VA-ECMO support treatment, combined with "lung rest" strategy, prone ventilation, restrictive fluid management, lung recruitment and other comprehensive treatment programs, was ultimately successful. Conclusion: Dynamic monitoring of white blood cells is helpful in determining the condition and prognosis. The inversion of the ratio of granulocytes to lymphocytes in children with severe pertussis and hyperleukopenia indicates a critical condition. Once routine treatment is ineffective and secondary organ dysfunction occurs in children with severe pertussis, ECMO can be considered a "salvage" supportive treatment method that endangers their lives.
期刊介绍：
Chinese Journal of Neurology was established in 1955, the predecessor of which is Chinese Journal of Neurology and Psychiatry. Chinese Journal of Neurology and Psychiatry has been indexed by MEDLINE until 1996, when it was divided into two journals, Chinese Journal of Neurology, and Chinese Journal of Psychiatry. Chinese Journal of Neurology is now indexed by EM, SCOPUS, AJ, WPRIM, CNKI, Wanfang Data, CSCD, etc. The impact factor of the journal is 2.755 in 2017, ranking the first among all neurological and psychological journals in China and among all the 142 medical journals published by the Chinese Medical Association. The journal is available both in print and online.
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