CAJ | 학술논문

目的总结甲型H1N1流感危重患者体外膜肺氧合(ECMO)支持治疗的方法和经验.方法 5例甲型H1N1流感危重症患者均在呼吸机辅助吸入氧浓度(FiO2)1.00时,动脉血氧饱和度(SaO2)0.70～0.85.男3例,女2例.5例患者分别经股静脉-颈内静脉置管采用V-V模式ECMO转流进行肺功能辅助,膜肺氧流量与血流量比为2～1∶1,吸入氧浓度0.21～1.00;呼吸机氧浓度0.30～0.70,呼吸末正压(PEEP)5～10 cm H2O;活化凝血时间(ACT)维持在160～250 s;在ECMO撤离观察期间关闭膜肺气体,动、静脉血氧饱和度和血气无明显变化后即可停ECMO并拔管,继续呼吸机辅助.结果 5例患者辅助时间48～330 h,平均178.2 h;ECMO辅助流量2.4～4.0 L/min;ECMO撤离观察时间4～24 h.4例患者顺利撤离ECMO过渡到呼吸机辅助呼吸,1例患者家属放弃治疗而死亡.结论股静脉-颈内静脉置管V-V模式ECMO转流可以为甲型H1N1流感危重患者提供有效的肺功能辅助,为患者过渡到适宜呼吸机辅助的状态争取时间.
목적 총결갑형H1N1류감위중환자체외막폐양합(ECMO)지지치료적방법화경험.방법 5례갑형H1N1류감위중증환자균재호흡궤보조흡입양농도(FiO2)1.00시,동맥혈양포화도(SaO2)0.70～0.85.남3례,녀2례.5례환자분별경고정맥-경내정맥치관채용V-V모식ECMO전류진행폐공능보조,막폐양류량여혈류량비위2～1∶1,흡입양농도0.21～1.00;호흡궤양농도0.30～0.70,호흡말정압(PEEP)5～10 cm H2O;활화응혈시간(ACT)유지재160～250 s;재ECMO철리관찰기간관폐막폐기체,동、정맥혈양포화도화혈기무명현변화후즉가정ECMO병발관,계속호흡궤보조.결과 5례환자보조시간48～330 h,평균178.2 h;ECMO보조류량2.4～4.0 L/min;ECMO철리관찰시간4～24 h.4례환자순리철리ECMO과도도호흡궤보조호흡,1례환자가속방기치료이사망.결론 고정맥-경내정맥치관V-V모식ECMO전류가이위갑형H1N1류감위중환자제공유효적폐공능보조,위환자과도도괄의호흡궤보조적상태쟁취시간.
Objective To summarize the clinical method and initial experience of extraeorporeal membrane oxygenation(ECMO)supportive treatment in influenza A H1N1 serious patients.Methods In 5 critically ill patients with influenza A H1N1,their arterial oxygen saturation was 0.70 to 0.85 with oxygen concentration(FiO2)1.00 under mechanical ventilation.In these 5 patients,3 males and 2 females,vein-vein mode ECMO bypass(femoral vein-internal jugular vein)was.carried out to assist pulmonary function.The ratio between ECMO oxygen flow and blood flow was 2-1∶1,FiO2 was 0.21 to 1.00,FiO2 for mechanical ventilation was 0.30 to 0.70,and positive end expiratory pressure(PEEP)was 5-10 cm H2O(1 cm H2O=0.098 kPa).Activated coagulation time(ACT)was maintained at 160-250 s.When artery oxygen saturation and artery-venous blood gas became normal on discontinuation of ECMO,ECMO was weaned,and venous cannulas were removed.Mechanical ventilation was continued.Results In 5 patients the assisting time of ECMO was 48-330 hours,the mean duration was 178.2 hours.ECMO assisted flow was 2.4-4.0 L/min.The observation time after stoppage of ECMO was 4-24 hours.Four patients were weaned from ECMO,with continuation of assisted respiration successfully.One patient died because the family member gave up hope and the treatment was stopped.Conclusion Vein-vein mode ECMO bypass through femoral vein-internal jugular vein can offer effective aid to pulmonary function in influenza A H1N1 patients who are critically ill.The strategy can win time for the patients to be able to continue mechanical ventilation treatment.