摘要
嗜铬细胞瘤是一组罕见的能够产生儿茶酚胺的肿瘤,临床主要以高血压、头痛、大汗、心悸为主,心源性休克很少为嗜铬细胞瘤的首发表现。笔者所在医院近期收治1例以心源性休克为首发临床表现的孕31+3周患者,初诊考虑为急性心肌炎并行静脉动脉体外膜肺氧合(VA-ECMO)治疗,心功能快速得到改善,但在ECMO撤机的过程中再度发生心源性休克,再次启动VA-ECMO辅助治疗。查腹部CT及24 h尿、血浆甲氧基肾上腺素类物质(MNs)明确诊断为嗜铬细胞瘤并儿茶酚胺心肌病,二次ECMO期间出现离心泵头血栓,在ECMO保护下紧急联合外科完成了肾上腺嗜铬细胞瘤切除,并于当日成功撤离ECMO,术后9 d产妇顺利出院。笔者总结本例产妇救治经过,并对相关病例报道进行回顾,为嗜铬细胞瘤并儿茶酚胺心肌病的临床救治提供参考。
Pheochromocytoma is a group of rare tumors produce catecholamines.Clinical manifestations are mainly hypertension,headache,sweating,and palpitation.Cardiogenic shock rarely appears as the first manifestation of pheochromocytoma.A pregnant patient of 31+3 weeks was admitted to our hospital recently with cardiogenic shock as the first clinical manifestation.Initial diagnosis was considered as acute myocarditis and veno-arterial extracorporeal membrane oxygenation(VA-ECMO)was started.Her cardiac function rapidly improved,however,cardiogenic shock occurred again during ECMO withdrawal,and VA-ECMO was started again.Though abdominal CT examination and 24 hour urine and plasma methoxyepinephrine substances(MNs),diagnosis of pheochromocytoma with catecholamine cardiomyopathy was confirmed.With ECMO assistance,adrenal pheochromocytoma was removed with surgery.The patient was successfully evacuated from ECMO on the surgery day,discharged successfully after 9 days.The authors summarized the treatments in this case and reviewed related case reports,which could provide reference to treat pheochromocytoma catecholamine cardiomyopathy.
作者
方可
笪欢欢
汪君
孙瑞祥
王涛
李阳
江海娇
鲁卫华
Fang Ke;Da Huanhuan;Wang Jun;Sun Ruixiang;Wang Tao;Li Yang;Jiang Haijiao;Lu Weihua(Department of Critical Care Medicine,the First Affiliated Hospital of Wannan Medical College(Yijishan Hospital),Anhui Provincial Clinical Research Center for Critical Respiratory Disease,Wuhu 241000,China;Anesthesia Operating Room,the First Affiliated Hospital of Wannan Medical College(Yijishan Hospital),Anhui Provincial Clinical Research Center for Critical Respiratory Disease,Wuhu 241000,China)
出处
《中华重症医学电子杂志》
CSCD
2023年第3期304-310,共7页
Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)
基金
安徽省医疗卫生重点专科建设项目(2021-273)
关键词
嗜铬细胞瘤
儿茶酚胺心肌病
心源性休克
体外膜肺氧合
肾上腺切除
妊娠
Pheochromocytoma
Catecholamine cardiomyopathy
Cardiogenic shock
Extracorporeal membrane oxygenation
Adrenal excision
Pregnancy
