中国防痨杂志2025，Vol.47Issue(8)：1014-1022,9.DOI:10.19982/j.issn.1000-6621.20250083
13例重症肺结核相关急性呼吸窘迫综合征实施体外膜肺氧合治疗患者临床特征及治疗转归
Clinical characteristics and treatment outcomes of extracorporeal membrane oxygenation in 13 patients with severe pulmonary tuberculosis-associated acute respiratory distress syndrome
摘要
Abstract
Objective:To investigate the clinical characteristics and treatment outcomes of patients with severe pulmonary tuberculosis(PTB)-associated acute respiratory distress syndrome(ARDS)who underwent extracorporeal membrane oxygenation(ECMO),and to provide evidence to inform clinical decision-making in this high-risk population.Methods:A retrospective observational study was conducted,enrolling 13 patients with severe PTB-associated ARDS who received ECMO support in the Intensive Care Unit(ICU)of Wuhan Pulmonary Hospital between October 2020 and October 2024.Clinical data were systematically collected,including demographic information,comorbidities,disease severity scores,radiological and microbiological findings,as well as treatment-related variables such as anti-TB regimens,respiratory support strategies,ECMO configurations,use of prone positioning,and corticosteroid administration.Outcomes assessed included survival rates,durations of ECMO support,mechanical ventilation,and ICU stay,along with ECMO-related complications.Results:Of the 13 patients included in the study,11(84.6％)were male,with a median age of 51 years and a median disease duration of 40 days.The mean Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score was 25.23±7.1 1,and the median Sequential Organ Failure Assessment(SOFA)score was 7(interquartile range(IQR):4,10).During ECMO support,12 patients(92.3％)developed secondary infections with other pathogens.Six patients were newly diagnosed with PTB and had not received anti-TB treatment prior to admission.Positive diagnostic results were observed in 10 patients(76.9％)via metagenomic next-generation sequencing(mNGS)or GeneXpert MTB/RIF,in 12(92.3％)via TB-DNA testing,and in 8(61.5％)via acid-fast bacilli(AFB)smear.Infiltrative PTB was identified in 8 patients(61.5％).Prone position ventilation was applied in 7 patients(53.8％)before ECMO initiation and in 6 patients(46.2％)during ECMO therapy.Venovenous ECMO(VV-ECMO)was employed in 10 patients(76.9％),venoarterial ECMO(VA-ECMO)in 2 patients(15.4％),and 1 patient(7.7％)underwent conversion from VV-ECMO to VA-ECMO.ECMO-related complications occurred in 6 patients(46.2％),with gastrointestinal bleeding reported in 5 cases.The duration of ECMO support ranged from 1 to 88 days.The median durations(IQR)were:13(9,31)days for ECMO,27(16,47)days for mechanical ventilation,and 32(23,57)days for ICU stay.Six patients(46.2％)showed clinical improvement and were discharged.The post-discharge survival rates at 28 and 60 days were 46.2％(6/13)and 30.8％(4/13),respectively.Conclusion:ECMO may improve survival in patients with severe PTB-associated ARDS and appears to offer a reasonable balance of efficacy and safety.However,careful patient selection and comprehensive assessment of disease severity are essential before ECMO initiation,with a thorough evaluation of potential benefits and risks.关键词
结核,肺/重症监护/通气机,机械/呼吸窘迫综合征,成人/体外膜氧合作用Key words
Tuberculosis,pulmonary/Intensive care/Ventilators,mechanical/Respiratory distress syndrome,adult/Extracorporeal membrane oxygenation分类
医药卫生引用本文复制引用
黄伟强,刘旭东,王丽丽,陈星星,商会会,徐雅,胡明..13例重症肺结核相关急性呼吸窘迫综合征实施体外膜肺氧合治疗患者临床特征及治疗转归[J].中国防痨杂志,2025,47(8):1014-1022,9.基金项目
武汉市卫健委科研项目(WX23A84) The Funding for Scientific Research Project from Wuhan Municipal Health Commission(WX23A84) （WX23A84）
