CAJ | 학술논문

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.
목적 탐토체외막폐양합(ECMO)재위중증환자호흡、순배쇠갈지지중적작용.방법 회고분석2007년10월1일지2009년12월26일북경대학제삼의원급북경지단의원중증감호병방(ICU)사용ECMO지지치료적위중증환자적림상자료.결과 9례ECMO치료환자중남성3례,녀성6례;평균년령(26.8±7.0)세;체질지수(28.3±9.1) kg/m2.2례인순배쇠갈행정맥-동맥(V-A)치료모식보조심공능,치료개시후혈관활성약물제량명현감소,심공능지표균현저개선;령7례인감염2009신형갑형H1N1류감반엄중급성호흡군박종합정(ARDS),상규궤계통기치료무효행정맥-정맥(V-V)모식보조폐공능,치료후호흡궤지지조건현저강저,동시동맥혈양포화도(SaO2)、동맥혈이양화탄분압(PaCO2)、혈pH치균명현개선.전부환자중5례발생급성신공능불전,6례출현고담홍소혈증,4례발생도관상관성혈행감염.최종5례성공탈궤(기중4례존활출원,1례사망),2례치료과정중사망,2례방기치료.9례환자평균수주현부홍세포(15.1±9.9)U,ICU주원시간(18.9±15.7)d.결론 ECMO능신속감경위중증환자심폐공작부하,개선심폐공능,병위기제공휴식급자행회복적궤회.감소상관병발증적발생시성공실시ECMO、개선환자예후적관건.
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infection in 4 patients.Five patients were weaned from ECMO successfully and 4 of them rehabilitated,the treatment was withdrawn in 2 patients,and the other 2 patients died during the procedure.The mean amount of red blood cell suspension administered per patients was (15.1 ±9.9) U,and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.