当前位置: X-MOL 学术BMC Pulm. Med. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Arnold-Chiari malformation type I and the posterior dislocation of the odontoid process aggravate prolonged weaning in a patient with severe viral pneumonia: a case report.
BMC Pulmonary Medicine ( IF 3.1 ) Pub Date : 2020-02-11 , DOI: 10.1186/s12890-020-1078-1
Renyu Ding 1, 2 , Yulan Meng 2 , Xingjuan Jia 2 , Xiaochun Ma 1
Affiliation  

BACKGROUND Prolonged and difficult weaning is associated with higher rates of complications and mortality. Therefore, it is important to identify the associated factors. CASE PRESENTATION We describe our experience with a 37-year-old man diagnosed with severe viral pneumonia (influenza A). He presented with acute respiratory failure type I on admission. During intubation, his blood pressure and heart rate decreased, and epinephrine and norepinephrine were administered. Although his clinical condition improved 8 days after intensive care unit (ICU) admission, he experienced difficulty weaning. He remained conscious but had a poor spontaneous cough with sputum production and weak limb muscle strength. His cough reflex was absent during bronchoscopic sputum suction, and he used abdominal breathing during the T-tube test. Magnetic resonance imaging revealed an Arnold-Chiari malformation type I, posterior dislocation of the odontoid process, and syringomyelia, with compression and deformation of the medulla and high cervical cord. The patient was successfully weaned from the ventilator at 20 days after ICU admission. CONCLUSIONS Arnold-Chiari malformation type I and posterior dislocation of the odontoid process, which aggravate medullary compression and increase the risk of cervical nerve injury, might be a rare factor affecting prolonged weaning in critical illness.

中文翻译:

严重病毒性肺炎患者的I型Arnold-Chiari畸形和齿状突后后脱位加重了断奶时间。

背景技术断奶时间长且困难与并发症和死亡率的增加相关。因此,确定相关因素很重要。病例介绍我们介绍了我们对一名37岁被诊断患有严重病毒性肺炎(甲型流感)的男子的经历。他在入院时出现了I型急性呼吸衰竭。在插管过程中,他的血压和心率下降,并服用了肾上腺素和去甲肾上腺素。尽管重症监护病房(ICU)入院8天后临床状况有所改善,但他仍断奶困难。他保持清醒,但自发性咳嗽较差,痰液产生且四肢肌肉力量较弱。在支气管镜吸痰期间没有咳嗽反射,并且在T管测试期间使用了腹部呼吸。磁共振成像显示I型Arnold-Chiari畸形,齿状突后脱位和脊髓空洞症,伴有髓质和高颈髓受压和变形。ICU入院20天后,该患者已成功从呼吸机断奶。结论I型Arnold-Chiari畸形和齿状突后牙脱位加剧了髓质压迫并增加了颈神经损伤的风险,这可能是影响严重疾病中断奶时间延长的罕见因素。
更新日期:2020-02-11
down
wechat
bug