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頁籤選單縮合
題名 | 輸血相關急性肺損傷之呼吸照護經驗=Clinical Experience of Respiratory Patient with Transfusion-Related Acute Lung Injury |
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作者 | 潘婷英; 莊逸君; 李綺婷; 黃美瑛; 游莉琪; Pan, Ting-ing; Chuang, I-chun; Li, Chi-ting; Huang, Mei-ying; Youg, Hi-ci; |
期刊 | 呼吸治療雜誌 |
出版日期 | 20090700 |
卷期 | 8:2 2009.07[民98.07] |
頁次 | 頁39-51 |
分類號 | 419.73 |
語文 | chi |
關鍵詞 | 輸血相關的急性肺損傷; 低血氧; 呼吸衰竭; Transfusion-related acute lung injury; TRALI; Hypoxemia; Respiratory failure; |
中文摘要 | 輸血相關的急性肺損傷(Transfusion-related acute lung injury, TRALI),在1985年首先於臨床研究發表36例個案報告。TRALI定義是輸血後4-6小時內新發生的急性肺損傷,屬於免疫性輸血的重度合併症,死亡率爲5-25%。其臨床症狀爲呼吸困難、低血氧、低血壓、兩側肺水腫和發燒等。此症候群的機轉原因不明,或許是因爲活化的嗜中性白血球釋出對細胞有毒的物質,使肺部微血管的滲透性增加。在處置方面,依其低血氧程度的嚴重不同而使用氧氣治療或呼吸器支持,若發生低血壓時則需補充液體維持血行動力學穩定。本個案是一個腎上腺功能不全患者,因腸阻塞與泌尿道感染疾病入病房,於住院期間因血色素降低而進行輸血治療,導致輸血相關的急性肺損傷(TRALI)合併呼吸衰竭,轉入加護病房緊急插氣管內管和呼吸器使用,經過治療後兩側肺水腫情況得以改善。臨床上,要確定診斷輸血相關的急性肺損傷較困難,藉由此次呼吸照護的經驗,再一次回顧認識此一症候群的支持性治療方式與呼吸器通氣治療中專業人員的角色。 |
英文摘要 | Transfusion-related acute lung injury (TRALI), a syndrome of acute lung injury (ALI) associated with blood transfusion was first described as a distinct clinical entity in 1985. The typical clinical presentation includes dyspnea, hypoxemia, hypotension, bilateral pulmonary edema, and fever. TRALI causes severe complications and is associated with a high mortality rate due to an immune-mediated transfusion reaction. The aggregation of polymorphonuclear granulocyes (PMNs) into the lung tissue plays a major role in the cascade of events leading to ALI. In the clinical setting, TRALI is often under-diagnosed because most clinicians have insufficient experience to recognize the correct diagnosis. Strategies for management of TRALI should emphasize adequate respiratory support and sufficient fluid supply. In this article, we present an example of an 82 year-old male with a history of adrenal insufficiency who was admitted due to ileus and urinary tract infection (UTI). Acute respiratory failure with hypoxemia developed after transfusion. The patient was therefore intubated for mechanical ventilatory support. The respiratory therapist plays a key role in managing respiratory care for TRALI in the intensive care unit. The main purpose of presenting this case report is to provide medical information and to share with respiratory practitioners our clinical experience of caring for TRALI. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。