The application of extracorporeal membrane oxygenation in critically ill patient

目的 探讨体外膜肺氧合(ECMO)在危重症患者呼吸、循环衰竭支持中的作用.方法 回顾分析2007年10月1日至2009年12月26日北京大学第三医院及北京地坛医院重症监护病房(ICU)使用ECMO支持治疗的危重症患者的临床资料.结果 9例ECMO治疗患者中男性3例,女性6例;平均年龄(26.8±7.0)岁;体质指数(28.3±9.1) kg/m2.2例因循环衰竭行静脉-动脉(V-A)治疗模式辅助心功能,治疗开始后血管活性药物剂量明显减少,心功能指标均显著改善;另7例因感染2009新型甲型H1N1流感伴严重急性呼吸窘迫综合征(ARDS),常规机械通气治疗无效行静脉-静脉(V-V)模式辅助肺功能,治疗后呼吸机支持条件显著降低,同时动脉血氧饱和度(SaO2)、动脉血二氧化碳分压(PaCO2)、血pH值均明显改善.全部患者中5例发生急性肾功能不全,6例出现高胆红素血症,4例发生导管相关性血行感染.最终5例成功脱机(其中4例存活出院,1例死亡),2例治疗过程中死亡,2例放弃治疗.9例患者平均输注悬浮红细胞(15.1±9.9)U,ICU住院时间(18.9±15.7)d.结论 ECMO能迅速减轻危重症患者心肺工作负荷,改善心肺功能,并为其提供休息及自行恢复的机会.减少相关并发症的发生是成功实施ECMO、改善患者预后的关键.Objective To evaluate the supportive effects on cardiopulmonary failure in critically ill patients treated with extracorporeal membrane oxygenation (ECMO).Methods A retrospective observational study of 9 patients treated in intensive care unit (ICU) of Peking University Third Hospital and Beijing Ditan Hospital from October 1,2007 to December 26,2009 with ECMO for various diseases was conducted.Clinical data was analyzed.Results Of 9 patients [mean age (26.8 ± 7.0) years,body mass index (28.3 ± 9.1 ) kg/m2] were enrolled,3 were male and 6 were female.Two patients were treated with veno-arterial (V-A) ECMO for severe heart failure,and 7 with veno-venous (V-V) ECMO due to refractory acute respiratory distress syndrome ARDS caused by 2009 novel H1N1 virus infection.The doses of vasoactive agents and cardiac parameters changed greatly after the V-A mode.The setting of ventilator support were significantly decreased,and arterial oxygen saturation (SaO2),arterial blood carbon dioxide partial pressure (PaCO2) and blood pH value were improved significantly after the V-V mode ECMO.Acute renal insufficiency occurred in 5 patients,hyperbihrubinemia in 6 patients, and catheter related blood stream infection in 4 patients.Five patients were weaned from ECMO successfully and 4 of them rehabilitated,the treatment was withdrawn in 2 patients,and the other 2 patients died during the procedure.The mean amount of red blood cell suspension administered per patients was (15.1 ±9.9) U,and length of ICU stay was (18.9± 15.7) days.Conclusions ECMO has a rapid effect to temporarily support heart or lung function (partially or totally ) during cardiopulmonary failure,leading to organ recovery.Attempts to reduce the incidence of complications might improve the prognosis of critically ill patients.首都医学发展科研基金PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)0286-892