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中华危重症医学杂志(电子版) ›› 2022, Vol. 15 ›› Issue (03) : 233 -237. doi: 10.3877/cma.j.issn.1674-6880.2022.03.011

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体外膜肺氧合救治嗜铬细胞瘤危象致心源性休克患者一例并文献复习
杨智超1, 宋志1,(), 彭相虹1, 戢德宇1, 王杰1, 叶冰洁1   
  1. 1. 518055 广东深圳,深圳大学总医院重症医学科
  • 收稿日期:2021-10-14 出版日期:2022-06-30
  • 通信作者: 宋志
  • 基金资助:
    深圳大学总医院科技人才助推计划(SUGH2019QD002)
  • Received:2021-10-14 Published:2022-06-30
引用本文:

杨智超, 宋志, 彭相虹, 戢德宇, 王杰, 叶冰洁. 体外膜肺氧合救治嗜铬细胞瘤危象致心源性休克患者一例并文献复习[J]. 中华危重症医学杂志(电子版), 2022, 15(03): 233-237.

嗜铬细胞是一种大多角形细胞,主要分布在肾上腺髓质、交感神经节等部位内的嗜铬组织中,具有合成、贮存和释放儿茶酚胺类激素(包括去甲肾上腺素、肾上腺素和多巴胺)的功能。嗜铬细胞瘤是起源于神经外胚层嗜铬组织的肿瘤,现临床中常指肾上腺髓质嗜铬细胞的肿瘤,能够合成、存储和分泌儿茶酚胺,并因后者的释放作用于肾上腺素能受体,引起血压剧烈波动、心悸、头痛和代谢紊乱等临床症状,短期内迅速加重时可能危及生命,被称为儿茶酚胺危象(嗜铬细胞瘤危象)[1,2]。在临床上此病如误诊或处理不当可能造成生命危险,近期深圳大学总医院诊治了1例嗜铬细胞瘤危象发生儿茶酚胺心肌病致心源性休克患者,现报告如下,并结合国内外相关文献加以探讨以增加对此疾病的认识。

图1 嗜铬细胞瘤危象致心源性休克患者CT及心脏彩超图注:a图为胸部CT,显示双肺下叶多发渗出并间质性改变;b~c图为腹部CT,显示右侧肾上腺内侧肢欠清,可见肿块影,大小约42 mm × 38 mm,内部密度欠均匀,可见片状低密度影,平均CT值约40 HU;d图为心脏彩超,显示左房、左室形态饱满,左室舒张功能降低,收缩功能差(射血分数28%)
图2 嗜铬细胞瘤危象致心源性休克患者胸部正位片注:a~d图分别ECMO第1、3、5日及撤机当日患者胸部正位片,显示双肺多发渗出性病变逐渐吸收
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