CAJ | 학술논문

目的观察体外膜肺氧合(ECMO)用于甲型H1N1流感所致重症肺炎时,如何通过肺休息实施肺保护策略.方法对5例甲型H1N1流感所致重症肺炎患者应用ECMO支持和不同机械通气策略进行治疗.其中2例死亡患者均采用同步间歇指令通气(SIMV)及双水平气道正压(BiPAP)通气模式,同时利用气道压力释放通气(APRV)模式进行控制性肺膨胀,复张压力设定在40 cm H_2O(1 cm H_2O=0.098 kPa).3例存活患者均应用肺休息策略,即逐渐抬高呼气末正压(PEEP),通过最佳顺应性寻找最佳PEEP,然后通过BiPAP模式将高水平压力(Phigh)设定为20 cm H_2O进行观察.结果死亡2例,其中1例因肺损伤反复出现自发性气胸伴脓毒症死亡;另1例死于多器官功能障碍综合征.3例采用肺休息治疗策略,最终康复.结论甲型H1N1流感所致重症肺炎患者应用ECMO治疗时,通过肺休息实施肺保护策略,可以明显改善预后,减少肺损伤的发生.
목적 관찰체외막폐양합(ECMO)용우갑형H1N1류감소치중증폐염시,여하통과폐휴식실시폐보호책략.방법 대5례갑형H1N1류감소치중증폐염환자응용ECMO지지화불동궤계통기책략진행치료.기중2례사망환자균채용동보간헐지령통기(SIMV)급쌍수평기도정압(BiPAP)통기모식,동시이용기도압력석방통기(APRV)모식진행공제성폐팽창,복장압력설정재40 cm H_2O(1 cm H_2O=0.098 kPa).3례존활환자균응용폐휴식책략,즉축점태고호기말정압(PEEP),통과최가순응성심조최가PEEP,연후통과BiPAP모식장고수평압력(Phigh)설정위20 cm H_2O진행관찰.결과 사망2례,기중1례인폐손상반복출현자발성기흉반농독증사망;령1례사우다기관공능장애종합정.3례채용폐휴식치료책략,최종강복.결론 갑형H1N1류감소치중증폐염환자응용ECMO치료시,통과폐휴식실시폐보호책략,가이명현개선예후,감소폐손상적발생.
Objective To study the effect of extracorporeal membrane oxygenation(ECMO)in patients suffering from severe pneumonia complicating influenza A H1N1 by putting lungs in rest to protect the latter.Methods Five patients with severe pneumonia following influenza A H1N1 were treated with ECMO and different modes of mechanical ventilation at the same time.Two patients died,both of them received synchronized intermittent mandatory ventilation(SIMV)and hi-level positive airway pressure (BiPAP)modes,with airway pressure release ventilation(APRV)to control lung expansion with expansion pressure 40 em H_2O(1 cm H_2O=0.098 kPa).In 3 survivors,the strategy of lung rest was performed by giving an optimized positive end expiratory pressure(PEEP)with an optimal compliance by gradually elevation of PEEP,and high-level pressure(Phigh)at 20 cm H_2O by application of BiPAP mode.Results One patient died due to lung damage and repeated spontaneous pneumothorax and sepsis;1 patient died due to multiple organ dysfunction syndrome.Three patients recovered after following the strategy of lung rest.Conclusion When ECMO is used for severe pneumonia complicating influenza A H1N1,prognosis can be obviously improved,with decrease in the occurrence of lung damage through the protection strategy of lung rest.