多發性肌炎併發呼吸衰竭之治療病例報告及文獻覆閱

Treatment of Polymyositis Complicated by Respiratory Failure: Case Report and Review of Literature

多發性肌炎或皮肌炎侵犯呼吸者並不多見，引起呼吸衰竭者更少之又少，文獻上有報告者僅有四例。我們報告一位45歲患多發性肌炎的女性病人，雖經使用高劑量corticosteroid與methotrexate治療，臨床情況仍逐漸惡化，終致呼吸衰竭，用上呼吸器。經嘗試cyclosporin十一星期後呼吸衰竭未見改善，後再嘗試血漿置換術終獲成功。多發性肌炎或皮肌炎合併呼吸衰竭之治療，目前仍未有一定有效之方法。對於此類疾病，應盡最大努力，嘗試各種治療方法，仍有成功之機會。

Polymyositis/ Dermatomyositis (PM/ DM) with respiratory muscle involvement was reported in 4~8% of cases. However, PM/ DM with respiratory failure requiring ventilator support were only seen in four reports. The treatment was still empirical. We will present a 45-year-old female suffering from polymyositis. Despite treatment with high dose corticosteroid and methotrexate, her pulmonary status deteriorated to the degree that ventilatory support was necessary. We had tried cyclosporin for 11 weeks but in vain. Then plasmapheresis was performed. She could be successfully weaned from ventilator finally.