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中华重症医学电子杂志 ›› 2021, Vol. 07 ›› Issue (01) : 88 -92. doi: 10.3877/cma.j.issn.2096-1537.2021.01.016

所属专题: 经典病例 文献

病例报告

新型冠状病毒肺炎疫情防控期间四脑室-延髓肿瘤切除术后ARDS救治一例及文献复习
谭彬彬1, 钱锦钰1, 李红1, 陈凤1, 梅璐1, 王霞1, 李雨泓1, 陈渝杰1,(), 鲜继淑1, 冯华1   
  1. 1. 400038 重庆,陆军军医大学第一附属医院神经外科
  • 收稿日期:2020-03-20 出版日期:2021-02-28
  • 通信作者: 陈渝杰
  • 基金资助:
    创伤、烧伤与复合伤国家重点实验室优秀青年基金项目(SKLYQ202002); 西南医院军事医学创新能力提升计划(SWH2018BJKJ-05)

Case report and literature review of acute respiratory distress syndrome after fourth ventricle-medulla oblongma tumor resection during novel coronavirus pneumonia pandemic

Binbin Tan1, Jinyu Qian1, Hong Li1, Feng Chen1, Lu Mei1, Xia Wang1, Yuhong Li1, Yujie Chen1,(), Jishu Xian1, Hua Feng1   

  1. 1. Department of Neurosurgery, the First Affiliated Hospital of Army Medical University, Chongqing 400038, China
  • Received:2020-03-20 Published:2021-02-28
  • Corresponding author: Yujie Chen
引用本文:

谭彬彬, 钱锦钰, 李红, 陈凤, 梅璐, 王霞, 李雨泓, 陈渝杰, 鲜继淑, 冯华. 新型冠状病毒肺炎疫情防控期间四脑室-延髓肿瘤切除术后ARDS救治一例及文献复习[J]. 中华重症医学电子杂志, 2021, 07(01): 88-92.

Binbin Tan, Jinyu Qian, Hong Li, Feng Chen, Lu Mei, Xia Wang, Yuhong Li, Yujie Chen, Jishu Xian, Hua Feng. Case report and literature review of acute respiratory distress syndrome after fourth ventricle-medulla oblongma tumor resection during novel coronavirus pneumonia pandemic[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(01): 88-92.

在新型冠状病毒肺炎疫情防控期间,陆军军医大学第一附属医院神经外科急诊收治一例四脑室-延髓肿瘤伴梗阻性脑积水患者。成功切除肿瘤后患者继发急性呼吸窘迫综合征,影像学及血液检查指标高度疑似新型冠状病毒感染,且患者合并甲型和乙型流感病毒既往感染,对医护人员鉴别诊断、临床救治及疫情防控提出挑战。本文报告该病例的综合救治及应急处理,并结合文献分析神经源性肺水肿形成原因,指导我们在脑与外周器官交互作用基础上为神经重症患者提供更有利的医疗决策。

During the pandemic of novel coronavirus pneumonia, a patient with fourth ventricle-medulla tumor and obstructive hydrocephalus was admitted into the Neurosurgical Department of the First Affiliated Hospital of Army Military Medical University. After successful resection of the tumor, this patient developed acute respiratory distress syndrome in a very short period, acute 2019-nCoV infection need to be ruled out with an image of infiltration and elevated blood biomarkers. She had a medical history of influenza A and B virus infection, which posed challenges in differential diagnosis, clinical treatment and personal prevention for medical staffs. This case report exhibits the comprehensive treatment and emergency control procedures in COVID-19 pandemic, and further analyzes potential mechanism of neurogenic pulmonary edema based on brain-lung crosstalk theory, which might help to provide appropriate medical decisions for patients with severe neurological diseases in the future.

图1 术前(2月10日)四脑室-延髓肿瘤术后并发急性呼吸窘迫综合征患者头颅MRI及胸部CT影像。图a为头颅MRI,箭头所示为四脑室-延髓肿瘤;图b为胸部CT
图2 术后第1天(2月18日)四脑室-延髓肿瘤术后并发急性呼吸窘迫综合征患者头颅CT及胸部CT影像。图a为头颅CT;图b为胸部CT,箭头所示为右下肺少许磨玻璃样片状病灶
图3 四脑室-延髓肿瘤术后并发急性呼吸窘迫综合征患者床旁胸部X线影像。图a为术后第3天(2月20日);图b为术后第5天(2月22日)
1
中华人民共和国国家卫生健康委员会. 新型冠状病毒肺炎诊疗方案(试行第八版)[EB/OL].

URL    
2
胡瑞, 黄楠, 陈文, 等. 新型冠状病毒肺炎确诊与疑似患者的临床和胸部CT影像比较 [J]. 中华放射学杂志, 2020, 54(5): 440-444.
3
中华人民共和国国家卫生健康委员会. 新型冠状病毒肺炎诊疗方案(试行第六版)[EB/OL].

URL    
4
Meyer S, Lindinger A, Löffler G, et al. Mechanisms of disease/hypothesis: neurogenic left ventricular dysfunction and neurogenic pulmonary oedema [J]. Wien Med Wochenschr, 2009, 159(13-14): 342-345.
5
Doba N, Reis DJ. Acute fulminating neurogenic hypertension produced by brainstem lesions in the rat [J]. Circ Res, 1973, 32(5): 584-593.
6
Bilik M, Karlinski M, Czlonkowska A. Acute respiratory distress syndrome as a manifestation of brain stem tumour--a case report [J]. Neurol Neurochir Pol, 2009, 43(6): 570-574.
7
Wright RS, Feuerman T, Brown J. Neurogenic pulmonary edema after trigeminal nerve blockade [J]. Chest, 1989, 96(2): 436-438.
8
Mori I, Diehl AD, Chauhan A, et al. Selective targeting of habenular, thalamic midline and monoaminergic brainstem neurons by neurotropic influenza A virus in mice [J]. J Neurovirol, 1999, 5(4): 355-362.
9
Huang CC, Liu CC, Chang YC, et al. Neurologic complications in children with enterovirus 71 infection [J]. N Engl J Med, 1999, 341(13): 936-942.
10
Zhang SY, Clark NE, Freije CA, et al. Inborn Errors of RNA Lariat Metabolism in Humans with Brainstem Viral Infection [J]. Cell, 2018, 172(5): 952-965.e18.
11
Michalicova A, Bhide K, Bhide M, et al. How viruses infiltrate the central nervous system [J]. Acta Virol, 2017, 61(4): 393-400.
12
Barbosa-silva MC, Santos LE, Rangel B. The impact of non-neurotropic influenza strains on the brain: a role for microglial priming? [J]. J Neurosci, 2018, 38(36): 7758-7760.
13
Busl KM, Bleck TP. Neurogenic pulmonary edema [J]. Crit Care Med, 2015, 43(8): 1710-1715.
14
Force ADT, Ranieri VM, Rubenfeld GD, et al. Acute respiratory distress syndrome: the Berlin definition [J]. JAMA, 2012, 307(23): 2526-2533.
15
刘红升, 苏琴, 赵晓东, 等. 神经源性肺水肿早期形式的急诊识别及治疗 [J]. 中国医学科学院学报, 2015, 37(3): 343-347.
16
Sedy J, Kunes J, Zicha J. Pathogenetic mechanisms of neurogenic pulmonary edema [J]. J Neurotrauma, 2015, 32(15): 1135-1145.
17
Mascia L. Acute lung injury in patients with severe brain injury: a double hit model [J]. Neurocrit Care, 2009, 11(3): 417-426.
18
Chang LY, Huang YC, Lin TY. Fulminant neurogenic pulmonary oedema with hand, foot, and mouth disease [J]. Lancet, 1998, 352(9125): 367-368.
19
Keegan MT, Lanier WL. Pulmonary edema after resection of a fourth ventricle tumor: possible evidence for a medulla-mediated mechanism [J]. Mayo Clin Proc, 1999, 74(3): 264-268.
20
Matsuyama T, Okuchi K, Nishiguchi T, et al. Neurogenic pulmonary edema caused by a medulla oblongata lesion after head trauma [J]. J Trauma, 2007, 63(3): 700-702.
21
Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. [J]. JAMA Neurol, 2020, 77(6): 683-690.
22
王旋, 姜晓兵, 赵洪洋. 神经外科面对新型冠状病毒肺炎的应急流程管理及防控策略(第一版) [J]. 中华神经外科杂志, 2020, 36(3): 217-220.
23
Ware LB, Girard TD. Acute lung injury: surprisingly common in the neurologic intensive care unit [J]. Crit Care Med, 2012, 40(2): 694-695.
24
张丽娜, 艾宇航. 重症神经:脑与脑外器官 [J/OL]. 中华重症医学电子杂志, 2018, 4(3): 226-230.
25
Sasannejad C, Ely EW, Lahiri S. Long-term cognitive impairment after acute respiratory distress syndrome: a review of clinical impact and pathophysiological mechanisms [J]. Crit Care, 2019, 23(1): 352.
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