体外循环心脏手术后体外膜肺氧合肺支持

目的 回顾性分析体外膜肺氧合(ECMO)在冠状动脉搭桥术(CABG)后肺支持的临床经验。方法 使用股动、静脉插管和Medtronic Carmeda ECMO系统对1例CABG术后严重呼吸功能衰竭患者进行静脉-动脉呼吸支持(V-A ECMO)。对患者术中的动脉血气分析、水电解质及酸碱平衡及X线肺部变化等方面进行了连续观察。结果 ECMO术中维持较理想的动脉血气和水电解质及酸碱平衡，ECMO19h患者恢复清醒，术中肺水肿明显改善，呼吸支持27h50mins后撤离ECMO，但术后35h死于循环衰竭。结论 V-A ECMO可提供有效的肺功能支持，并为肺部水肿的恢复和临床进一步处理创造了机会。

Veno-Arterial Extracorporeal Membrane Oxygenation for Respiratory Support in the Patient After Cardiac Surgery

OBJECTIVE To retrospectively review the clinical experiences of extracorporeal membrane oxygenation (ECMO) for respiratory support in a patient after coronary artery bypass grafting. METHODS Veno-Arterial (V-A) ECMO with a Medtronic Carmeda coated system was used in a patient with severe respiratory failure after coronary artery bypass grafting (CABG). Blood gas analysis, water balance, electrolyte and acid-base state, and chest X-ray were evaluated during the procedure.RESULTS The patient was weaned from ECMO after 27 hours and 50 minutes, but died of circulatory failure 35 hours later.CONCLUSION Our experience suggests that V-A ECMO may provide efficient respiratory support in a patient with post-cardiotomy respiratory failure.