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体外膜肺氧合救治免疫检查点抑制剂相关肺炎合并重度ARDS患者1例
Authors Meng Y, Yuan Y, Ma L, Wang J, Zhang B
Received 2 December 2024
Accepted for publication 15 March 2025
Published 26 March 2025 Volume 2025:18 Pages 411—419
DOI http://doi.org/10.2147/IMCRJ.S507273
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Vinay Kumar
摘要：本文回顾性分析1例肺恶性肿瘤术后使用替雷利珠单抗所致免疫相关性肺炎合并重度ARDS患者的诊疗经过：前期有创机械通气实施肺保护性通气策略氧合未改善，遂行静脉-静脉体外膜肺氧合（VV-ECMO），期间发生导管相关感染、溶血、膜肺血栓形成等并发症，后实施清醒VV-ECMO，仍存在撤机困难，再次鉴别疾病明确诊断为免疫检查点抑制剂相关肺炎，规范治疗后最终得以好转。对于已接受有创机械通气的重度ARDS患者，第一时间应规范实施肺保护性通气策略、条件允许下俯卧位通气，若氧合仍不能改善，结合心功能选择体外膜肺氧合方式，实施ECMO，熟练掌握相关并发症及处理；另斟酌清醒ECMO利弊，学会鉴别发热伴肺部阴影相关疾病以精准治疗。
