CAJ | 학술논문

目的总结体外膜肺氧合(ECMO)在肺移植围手术期应用的经验.方法 30例原发性终末期肺病伴继发性肺动脉高压的患者在肺移植术中应用了ECMO,其中单肺移植18例,不横断胸骨序贯式双肺移植12例.在术前使用ECMO维持者2例,分别维持19 d和6 d;其他患者在麻醉完成后开始置ECMO管道.受者在氧合和血流动力学平稳后撒除ECMO.结果所有受者均顺利完成移植.27例于移植术后顺利撤除ECMO;3例术后继续使用ECMO,其中2例分别于术后36 h和7 d时顺利撤除,另1例未能撤除ECMO,术后5 d出现急性肾功能衰竭,术后2周时死于多器官功能衰竭.发生股动、静脉切口感染并发症者2例,股动脉血栓形成(中度)者1例,经治疗后均好转.结论体外膜肺氧合可应用于伴有原发性或继发性肺动脉高压患者的肺移植手术,其并发症的发生可能与患者病情较重、血流动力学不稳定等因素有关,早期发现和积极有效地治疗可以改善患者的预后.
목적 총결체외막폐양합(ECMO)재폐이식위수술기응용적경험.방법 30례원발성종말기폐병반계발성폐동맥고압적환자재폐이식술중응용료ECMO,기중단폐이식18례,불횡단흉골서관식쌍폐이식12례.재술전사용ECMO유지자2례,분별유지19 d화6 d;기타환자재마취완성후개시치ECMO관도.수자재양합화혈류동역학평은후살제ECMO.결과소유수자균순리완성이식.27례우이식술후순리철제ECMO;3례술후계속사용ECMO,기중2례분별우술후36 h화7 d시순리철제,령1례미능철제ECMO,술후5 d출현급성신공능쇠갈,술후2주시사우다기관공능쇠갈.발생고동、정맥절구감염병발증자2례,고동맥혈전형성(중도)자1례,경치료후균호전.결론 체외막폐양합가응용우반유원발성혹계발성폐동맥고압환자적폐이식수술,기병발증적발생가능여환자병정교중、혈류동역학불은정등인소유관,조기발현화적겁유효지치료가이개선환자적예후.
Objective To explore the perioperative application of extracorporeal membrane oxygenation (ECMO) in lung transplantation. Methods Thirty patients with primary and end-stage pulmonary disease accompanied by pulmonary hypertension were subjected to operation under the accessory of ECMO. Eighteen patients received single-lung transplantation and 12 patients bilateral sequential lung transplantation without sternal division in our hospital from November 2005 to July 2009. In 2 patients ECMO was given before operation and maintained for 19 days and 6 days respectively. In the remaining patients, ECMO pipeline was placed after anesthesia. After lung trarnsplantation,ECMO was removed after the recipients' oxygen saturation and hemodynamics were stable. Results In all recipients lung transplantation was successfully done. ECOM was removed in 27recipients after operation, and the rest 3 recipients were supported by ECMO after operation: the ECMO was removed at 36th h and 7th day after lung transplantation in two patients respectively,and another one was supported by ECMO for 5 days after operation and suffered acute kidney failure, and died of multiple organ failure 2 weeks post-transplantation. Two recipients were infected in thigh arteriovenous cut and one suffered femoral artery thrombosis, but all of them got better and discharged from hospital after treatment. Conclusion ECMO can be used for lung transplantation on patients with primary and secondary pulmonary hypertension. The complications may be associated with patients'serious condition and unstable hemodynamics. Early detection and active and effective treatment can improve patient's prognosis.