Lung transplantation after paraquat poisoning in an adolescent: one case report and literature review
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摘要:
目的 总结百草枯中毒患者中毒后移植时机以及相关处理措施对预后的影响。 方法 回顾性分析1例百草枯中毒行双肺移植术治疗患者的临床资料，总结分析该例患者的临床表现、辅助检查以及诊治经过。 结果 1例17岁青少年在摄入25%百草枯20～30 mL后出现恶心、呕吐、咳嗽伴全身乏力入院。患者经对症支持治疗后，氧饱和情况无改善，肺部纤维化持续进展，遂在体外膜肺氧合（ECMO）辅助下行序贯双侧肺移植。经术后康复治疗，并积极防治并发症，患者于术后50 d出院。 结论 百草枯中毒后的移植时机可选择在肝肾功能开始恢复时，围手术期主动、有针对性地预防潜在致病性细菌感染，以及早期康复训练有助于改善肺移植受者的预后。 Abstract:Objective To summarize the effect of the timing of lung transplantation and related treatment measures on clinical prognosis of patients with paraquat poisoning. Methods Clinical data of a patient with paraquat poisoning undergoing bilateral lung transplantation were retrospectively analyzed. Clinical manifestations, auxiliary examination, diagnosis and treatment of this patient were summarized and analyzed. Results A 17-year-old adolescent was admitted to hospital due to nausea, vomiting, cough and systemic fatigue after oral intake of 20-30 mL of 25% paraquat. After symptomatic support treatment, the oxygen saturation was not improved, and pulmonary fibrosis continued to progress. Therefore, sequential bilateral lung transplantation was performed under extracorporeal membrane oxygenation (ECMO). After postoperative rehabilitation and active prevention and treatment for postoperative complications, the patient was discharged at postoperative 50 d. Conclusions The timing of lung transplantation after paraquat poisoning may be selected when the liver and kidney function start to recover. Active and targeted prevention of potential pathogen infection in perioperative period and early rehabilitation training contribute to improving clinical prognosis of lung transplant recipients. -
图 1 患者入院到术前的血气结果变化
Figure 1. Changes in blood gas results between admission and pre-operation
图 2 肺移植术前及术后肺部CT图像
注：A图示双侧肺纤维化进展；B图示肺移植术后肺部CT未见纤维化。
Figure 2. CT images of lung before and after lung transplantation
图 3 患者入院到术前肝肾功能变化
Figure 3. Changes of liver and kidney function between admission and pre-operation
表 1 文献报道的百草枯中毒肺移植受者的临床资料
Table 1. Clinical data of paraquat poisoning lung transplant recipients reported in the literature
研究者 年份 患者年龄
（岁）术前肝
功能术前肾
功能中毒到移植
的时间（d）ECMO使用
时间（d）ECMO
方式肺移植
类型术后生存
时间Matthew H, et al[4] 1968 15 异常 异常 6 －① － 单肺 19 d Cooke NJ, et al[12] 1973 18 异常 异常 10 － － 单肺 12 d 未列出[13] 1985 31 － 异常 19 14 V-V 双肺 110 d Walder B, et al[14] 1997 17 － 异常 44 44 体外循环 单肺 >2年 Jiao GH, et al[15] 2014 24 稳定 稳定 56 44 V-V 双肺 >5年 Jiao GH, et al[15] 2018 45 稳定 稳定 38 38 V-V 双肺 >3年 Jiao GH, et al [15] 2020 38 稳定 稳定 27 27 V-A② 双肺 >7个月 Jiao GH, et al [15] 2021 30 稳定 稳定 28 28 V-V 双肺 >7个月 Tang X, et al[16] 2015 21 恢复 恢复 56 44 V-V 双肺 >1年 Jiang WZ, et al[17] 2019 26 － － 58 35 V-V/V-A 双肺 >1年 Wu Y, et al[18] 2022 18 － － 34 34 － 双肺 >1年 注：①－为文献未报道。
②V-A 为静脉-动脉。
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