上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 病例报告 • 上一篇    下一篇

盐酸气体吸入致急性呼吸窘迫综合征1例报道

张丽妍1,2,谭晓明1,2,李燕芹2,蒋捍东1,2   

  1. 上海交通大学 医学院 1.附属仁济医院南院呼吸科， 上海 201112； 2.附属仁济医院呼吸科, 上海 200127
  • 出版日期:2015-12-28 发布日期:2016-01-21
  • 通讯作者: 蒋捍东, 电子信箱: jianghd@163.com。
  • 作者简介:张丽妍（1985—）， 女， 住院医师， 硕士生; 电子信箱: leeyan_516@163.com。

Hydrochloric acid-induced acute respiratory distress syndrome: one case report

ZHANG Li-yan1,2, TAN Xiao-ming1,2, LI Yan-qin2, JIANG Han-dong1,2   

  1. 1.Department of Respiratory Medicine, Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine, Shanghai201112, China； 2.Department of Respiratory Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai200127, China
  • Online:2015-12-28 Published:2016-01-21

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摘要：

目的  探讨盐酸气体吸入引起的急性呼吸窘迫综合征（ARDS）临床特点及治疗方法。方法  报道1例双相水平气道正压通气（BIPAP）联合吡非尼酮（PFD）治疗盐酸气体吸入致ARDS患者的临床资料，复习文献探讨治疗特点。结果  男性患者，33岁，因吸入浓盐酸气体后出现咳嗽、咳痰伴胸闷、气促就诊。CT示两肺弥漫性改变，手指脉搏血氧饱和度75%，以“吸入性肺炎，ARDS”收治入院，经BIPAP辅助通气、PFD抗纤维化等治疗后患者氧合改善，临床症状好转，两肺纤维灶减少。结论  早期BIPAP的应用可以显著降低ARDS患者的插管率以及病死率。ARDS纤维化期予以PFD可以防止甚至逆转纤维化。

关键词: 双相水平气道正压通气, 吡非尼酮, 急性呼吸窘迫综合征

Abstract:

Objective  To explore the clincial characteristics and therapy of hydrochloric acid gas inhalation-induced acute respiratory distress syndrome (ARDS). Methods  Clinical date of an ARDS following inhalation of hydrochloric acid gas treated by bilevel positive airway pressure (BIPAP) vetilation with pirfenidone (PFD) was reported. Literature was reviewed to investigate the treatment characteristics. Results  A 33-year-old male patient was admitted to our department due to cough, expectoration, chest distress and shortness of breath after hydrochloric acid gas inhalation. Lung CT showed diffuse interstitial pulmonary damage. Oxygen saturation decreased to 75%. The patient was diagnosed as “aspiration pneumonia and ARDS”. The oxygenation and clinical symptoms were improved via BIPAP ventilation combined with PFD. The fibrous foci of two lungs reduced. Conclusion  Early application of BIPAP can significantly reduce the intubation rate and mortality of ARDS.  PFD can delay the process of pulmonary fibrosis, and even reversed.

Key words: bilevel positive airway pressure, pirfenidone, acute respiratory distress syndrome