Điều trị suy giảm chức năng thất trái nặng trong sốc nhiễm trùng bằng phương pháp oxy hoá qua màng ngoài cơ thể

Tóm tắt

Bệnh cơ tim do nhiễm trùng hệ thống (SCM) là tình trạng co bóp nội tại cơ tim bị suy giảm dẫn đến giảm cung lượng tim. Báo cáo người bệnh (NB) nữ 31 tuổi bị U màng phổi phải, được mổ lấy u. Sau mổ 6 giờ thì sốt cao, huyết động suy giảm nhanh, phải dùng thuốc vận mạch liều cao, truyền dịch, kháng sinh,… nhưng đáp ứng rất kém. Siêu âm thấy vận động cơ tim suy giảm nặng, men tim, các dấu ấn nhiễm trùng tăng cao,… Chẩn đoán: SCM suy giảm chức năng thất trái nặng, chỉ định ECMO V-A hỗ trợ. Sau 8 ngày ECMO, chức năng thất trái đã hồi phục tốt, ngừng ECMO, NB ra viện. Các nghiên cứu dùng ECMO điều trị SCM thấy: ECMO có thể là điều trị cứu cánh trong khi chờ cơ tim hồi phục.

Từ khoá: Nhiễm trùng hệ thống, bệnh lý cơ tim do nhiễm trùng hệ thống, oxy hoá màng ngoài cơ thể.

Treatment of severe left ventricular failure induced by septic shock through extracorporeal oxygenation

Pham Tien Quan, Ta Thi Huyen Trang, Nguyen Kim Dan

Viet Duc University Hospital

Abstract

Sepsis-induced cardiomyopathy (SCM) is a condition in which the intrinsic contractility of the heart muscle is impaired, leading to reduced cardiac output. We report a case of a 31-year-old female patient with a right pleural tumor who underwent tumor resection surgery. Six hours postoperatively, she developed a high fever and rapid hemodynamic deterioration, requiring high doses of vasoactive drugs, fluid resuscitation, antibiotics, and other supportive measures, but with poor response. Echocardiography revealed severe myocardial dysfunction, with significantly elevated cardiac enzymes and infection markers. Diagnosis: SCM with severe left ventricular dysfunction, requiring V-A ECMO support. Left ventricular function recovered well after 8 days using ECMO, allowing ECMO removal, and the patient was discharged. Studies in using ECMO to treat SCM have shown that it can be a temporary treatment while waiting for the heart muscle to recover.

Keywords: Sepsis, sepsis-induced myocardiopathy, extracorporeal membrane oxygenation.

Tài liệu tham khảo

1. Singer M, Deutschman CS, Seymour CW et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315: 801–10.
2. Beesley SJ, Weber G, Sarge T et al. Septic Cardiomyopathy. Critical Care Medicine 2018; 46: 625–34.
3. Vasconcelos-Cardoso M. A new path to prevent sepsis-induced cardiac dysfunction. Revista Portuguesa de Cardiologia 2023; 42: 905–6.
4. Xie M, Yan X, Li Y et al. Left Ventricular Myocardial Deformation in Sepsis or Septic Shock: An Observational Study of Serial Changes by Three-Dimensional and Two-Dimensional Echocardiography. In Review, 2022 [cited 2023 Nov 9]. doi: 10.21203/rs.3.rs-1294828/v1
5. Ling RR, Ramanathan K, Poon WH et al. Veno-arterial extracorporeal membrane oxygenation as mechanical circulatory support in adult septic shock: a systematic review and meta-analysis with individual participant data meta-regression analysis. Crit Care 2021; 25: 246.
6. Myers LC, Lee C, Thompson BT et al. Outcomes of Adult Patients With Septic Shock Undergoing Extracorporeal Membrane Oxygenation Therapy. The Annals of Thoracic Surgery 2020; 110: 871–7.
7. Baradaran Rahimi V, Rahmanian Devin P, Askari VR. Boswellia serrata inhibits LPS-induced cardiotoxicity in H9c2 cells: Investigating role of anti-inflammatory and antioxidant effects. Toxicon 2023; 229: 107132.
8. Chen X-S, Cui J-R, Meng X-L et al. Angiotensin-(1–7) ameliorates sepsis-induced cardiomyopathy by alleviating inflammatory response and mitochondrial damage through the NF-êB and MAPK pathways. Journal of Translational Medicine 2023; 21: 2.
9. LHeureux M, Sternberg M, Brath L et al. Sepsis-Induced Cardiomyopathy: a Comprehensive Review. Curr Cardiol Rep 2020; 22: 35.
10. Vieillard-Baron A, Millington SJ, Sanfilippo F et al. A decade of progress in critical care echocardiography: a narrative review. Intensive Care Med 2019; 45: 770–88.
11. Boissier F, Aissaoui N. Septic cardiomyopathy: Diagnosis and management. Journal of Intensive Medicine 2022; 2: 8–16.
12. Ravikumar N, Sayed MA, Poonsuph CJ et al. Septic Cardiomyopathy: From Basics to Management Choices. Current Problems in Cardiology 2021; 46: 100767.
13. Bréchot N, Hajage D, Kimmoun A et al. Venoarterial extracorporeal membrane oxygenation to rescue sepsis-induced cardiogenic shock: a retrospective, multicentre, international cohort study. The Lancet 2020; 396: 545–52.
14. Zhang H, Xu Y, Huang X et al. Extracorporeal membrane oxygenation in adult patients with sepsis and septic shock: Why, how, when, and for whom. Journal of Intensive Medicine 2023; S2667100X23000488.
15. Vogel DJ, Murray J, Czapran AZ et al. Veno-arterio-venous ECMO for septic cardiomyopathy: a single-centre experience. Perfusion 2018; 33: 57–64.
16. Towns ML, Jarvis WR, Hsueh P-R. Guidelines on Blood Cultures. Journal of Microbiology, Immunology and Infection 2010; 43: 347–9.