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

doi:10.3877/cma.j.issn.2096-1537.2021.01.016

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；文献资源库；

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. 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 Tan ¹, Jinyu Qian ¹, Hong Li ¹, Feng Chen ¹, Lu Mei ¹, Xia Wang ¹, Yuhong Li ¹, Yujie Chen ¹ ^, ^†( ), Jishu Xian ¹, Hua Feng 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

全文 ( 0 ) 下载PDF ( 4 )

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。

关键词: 延髓肿瘤, 新型冠状病毒肺炎, 急性呼吸窘迫综合征, 神经源性肺水肿, 脑肺交互作用

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.

Key words: Medulla oblongata tumor, Coronavirus disease 2019, Acute respiratory distress syndrome, Neurogenic pulmonary edema, Brain-lung crosstalk

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）

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