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中华重症医学电子杂志 ›› 2024, Vol. 10 ›› Issue (04) : 404 -408. doi: 10.3877/cma.j.issn.2096-1537.2024.04.016

所属专题: 经典病例

病例报告

免疫球蛋白联合依库珠单抗治疗GBS 并发重度ARDS 患者一例
杨东星1, 沈鹏2, 赵慧颖2,()   
  1. 1.061100 河北沧州,河北省沧州中西医结合医院重症医学科
    2.100044 北京,北京大学人民医院ICU
  • 收稿日期:2024-06-25 出版日期:2024-11-28
  • 通信作者: 赵慧颖
  • 基金资助:
    吴阶平医学基金会临床科研专项资助基金(320.6750.2022-2-34)

A case of severe acute respiratory distress syndrome complicated by Guillain-Barré syndrome treated with immunoglobulin combined with Eculizumab

Dongxing Yang1, Peng Shen2, Huiying Zhao2,()   

  1. 1.Department of Critical Care Medicine, Cangzhou Combined Hospital of Traditional Chinese and Western Medicine, Cangzhou 061100, China
    2.Department of Critical Care Medicine, People’s Hospital of Peking University, Beijing 100044,China
  • Received:2024-06-25 Published:2024-11-28
  • Corresponding author: Huiying Zhao
引用本文:

杨东星, 沈鹏, 赵慧颖. 免疫球蛋白联合依库珠单抗治疗GBS 并发重度ARDS 患者一例[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 404-408.

Dongxing Yang, Peng Shen, Huiying Zhao. A case of severe acute respiratory distress syndrome complicated by Guillain-Barré syndrome treated with immunoglobulin combined with Eculizumab[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2024, 10(04): 404-408.

吉兰-巴雷综合征(GBS)是一类免疫介导的急性炎性周围神经病,临床特征为急性起病。本例患者发病2 周前出现发热、咳嗽上呼吸道感染症状后逐渐出现肢体远端感觉异常、双下肢迟缓性肌无力,患者脑脊液常规、生化检查显示细胞-蛋白分离现象,病情进展迅速累及呼吸肌,造成呼吸衰竭、低氧血症,给予机械通气,患者胸部CT 示双肺弥漫性炎性渗出病变,符合GBS 并发重症急性呼吸窘迫综合征(ARDS)的诊断,患者于外院早期应用了免疫球蛋白及血浆置换治疗,但效果差,病情仍迅速恶化,出现呼吸衰竭、ARDS 症状。入我院后继续应用免疫球蛋白联合依库珠单抗治疗,患者病情得到有效控制,肌力迅速恢复,呼吸功能、氧合指数逐步改善,顺利脱离机械通气支持。

Guillain-Barré syndrome (GBS) is an immune-mediated acute inflammatory polyneuropathy, characterized by its acute onset.This patient presented with symptoms of fever and cough following an upper respiratory tract infection two weeks before the onset of the disease, which gradually progressed to sensory disturbances in the distal extremities and flaccid weakness in the lower limbs.Routine cerebrospinal fluid (CSF) analysis and biochemical tests revealed the phenomenon of cytoalbuminological dissociation.The condition rapidly evolved to involve the respiratory muscles, leading to respiratory failure and hypoxemia, necessitating mechanical ventilation.CT scan of the patient’s chest demonstrated diffuse alveolar infiltrates, consistent with a diagnosis of GBS complicated by severe acute respiratory distress syndrome(ARDS).Despite early treatment with intravenous immunoglobulin and plasmapheresis at another facility with suboptimal outcomes and rapidly deteriorating condition, manifesting respiratory failure and symptoms of ARDS, in this case, we continued treatment with intravenous immunoglobulin in conjunction with Eculizumab.This approach effectively controlled the ARDS, led to a swift recovery of muscle strength, and progressively improved respiratory function and oxygenation indices, ultimately allowing for the successful weaning from mechanical ventilation support.

图1 吉兰-巴雷综合征并发重症急性呼吸窘迫综合征患者胸部CT。图a、b 为入院当日外院胸部横断面、冠状面CT 影像学改变,示双肺弥漫性磨玻璃样炎性渗出;图c、d 为入院第2 天复查胸部不同横断面CT 影像学改变,示双肺弥漫性炎性渗出稍有吸收;图e、f 为入院第7 天复查胸部不同横断面CT 影像学改变,示双肺炎性渗出较前明显吸收
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