体外膜肺氧合治疗重症急性呼吸窘迫综合征的护理

目的总结体外膜肺氧合（ECMO）治疗重症急性呼吸窘迫综合征（ARDS）的临床护理策略。方法对22例机械通气效果不佳的重症ARDS患者应用ECMO治疗，同时合理调配护理人员，加强病房环境管理及各项生命指标的监测等。结果ECMO治疗24h后，患者氧代谢情况明显改善；住院治疗25～43d，治愈16例，死亡6例。结论严密监测和有效的护理是ECMt）治疗成功的重要保证。     

体外膜肺氧合治疗重症急性呼吸窘迫综合征的护理

目的 总结体外膜肺氧合(ECMO)治疗重症急性呼吸窘迫综合征(ARDS)的临床护理策略.方法 对22例机械通气效果不佳的重症ARDS患者应用ECMO治疗,同时合理调配护理人员,加强病房环境管理及各项生命指标的监测等.结果 ECMO治疗24 h后,患者氧代谢情况明显改善;住院治疗25～43 d,治愈16例,死亡6例.结论 严密监测和有效的护理是ECMO治疗成功的重要保证.     

急性重症胰腺炎合并ARDS的治疗

本文回顾性报告３例急性重症胰腺炎合并ＡＲＤＳ的成功治疗。证明传统的机械通气是治疗ＡＲＤＳ的有效手段。     

重症急性胰腺炎并发ARDS诊治的探讨

为探讨重症急性胰腺炎并发ＡＲＤＳ的统一诊断标准和及时有效治疗方案。作者总结了１９８７年１月－１９９１年１２月及１９９２年１月－１９９５年１２月采用“ＡＲＤＳ先兆”诊治方案前后的先兆组Ｉ和先兆Ⅱ的临床资料。分析了“ＡＲＤＳ先兆”的发生率。比较两组开始机械通气时ＰａＯ２值，演变为ＡＲＤＳ的百分率，病死率，及死亡原因。     

内给氧在重症急性胰腺炎非手术治疗中的应用

目的 观察内给氧治疗重症急性胰腺炎的临床效果.方法 对2005年2月至2009年3月期间收治的55例重症急性胰腺炎患者采用非手术治疗,在给予奥曲肽或施他宁、抗生素及基础性支持治疗的基础上,按入院时间先后分为2组,试验组(n=28)给予注射用内给氧治疗1周,对照组(n=27)未用内给氧.结果 试验组动脉血氧分压在应用内给氧治疗前为(53.8±8.1) mm Hg,治疗后为(87.9±9.5) mm Hg;血氧饱和度治疗前为(81.1±7.4)%,治疗后为(93.2±6.7)%;治愈病例中血淀粉酶降至正常的时间,试验组平均为(29.4±7.2) h,对照组平均为(162.1±46.8) h;死于急性呼吸窘迫综合征者试验组为0(0/28),对照组为14.8%(4/27);上述指标差异均有统计学意义(P＜0.05).结论 内给氧配合基础性治疗对重症急性胰腺炎有较好疗效,实用性较强.     

重症急性胰腺炎并发急性呼吸窘迫综合征患者的护理

回顾23例重症急性胰腺炎(SAP)并发急性呼吸窘迫综合征(ARDS)患者的监测和护理。认为严密监测呼吸频率、节律，指端血氧饱和度，动脉血气分析，氧合指数等指标，及时液体复苏、缓解腹腔高压，加强用药管理，预防呼吸机并发症是确保救治成功的重要护理措施。     

体外膜肺氧合在严重创伤后重度急性呼吸窘迫综合征中的疗效观察

目的探讨体外膜肺氧合(ECMO)治疗严重创伤后重度急性呼吸窘迫综合征(ARDS)的疗效。方法分析2019年7月至2022年6月郑州大学第二附属医院接受V-V ECMO治疗的严重创伤后重度ARDS的13例患者临床资料, 总结行ECMO支持的时机、治疗期间的并发症及ECMO运行情况。采用t检验分析结果差异。结果 13例严重急性呼吸窘迫综合征患者均接受了V-V ECMO治疗, ECMO前氧合指数为42～58。ECMO辅助前机械通气时间为2.92 d(1～5 d)。13例患者均成功下机。2例术后死于感染性休克, 1例术后因脑出血死亡。最终10例患者存活。在成功脱机的13例受试者中, V-V ECMO辅助了148.8 h(72～264 h)。在10例存活的受试者当中, 1例出现截瘫, 1例发生肌无力, 两者都与原发性创伤有关, 1例发生肾功能不全, 6周后恢复。ECMO辅助前后动脉血气分析指标酸碱度(PH)(7.14±0.05比7.32±0.02, t=-6.30, P<0.01)、血氧分压(PO2)[(47.54±1.38) mmHg比(111.77±7.75) mmHg, t=-8.6...     

体外膜氧合在肝移植术后儿童重度急性呼吸窘迫综合征中的应用

目的探讨体外膜氧合(ECMO)在肝移植术后重度急性呼吸窘迫综合征(ARDS)儿童受者的应用。方法回顾性分析天津市第一中心医院接受ECMO支持的2例儿童肝移植受者术后重度ARDS的临床资料,其中1例疑诊卡氏肺孢子菌肺炎,另1例确诊卡氏肺孢子菌肺炎。结果 2例儿童受者均采用静脉-动脉(V-A)ECMO模式,ECMO开始前的氧饱和度指数(OSI)分别为31.8和23.9。2例分别在ECMO支持219 h和168 h后成功撤除ECMO;分别在有创机械通气342 h和232 h后撤除呼吸机;ICU停留时间分别为31 d和18 d;住院时间分别为57 d和33 d。2例儿童肝移植受者ECMO支持期间移植肝功能稳定,无新发脏器功能不全,无可致命并发症发生。结论 ECMO是儿童肝移植受者术后重度ADRS的一种有潜力的治疗手段,ECMO治疗相关并发症的评估及管理有待进一步研究。     

重症急性胰腺炎并发急性呼吸窘迫综合征15例防治体会

急性呼吸窘迫综合征 (ＡＲＤＳ)是重症急性胰腺炎早期主要并发症之一 ,病死率高达 5 0 %左右。本文回顾 1989～ 1999年我院收治的重症急性胰腺炎并发ＡＲＤＳ者 15例 ,分析结果如下。临床资料1.一般资料 :本组男 10例 ,女 5例 ,年龄 3 0～ 67岁 ,年龄>5 5岁 8例。感染性休克 3例 ,腹膜炎体征 15例 ,腹穿血性腹水 12例。2 .诊断标准 :重症急性胰腺炎按 1996年中华医学会外科学会胰腺分会统一标准[1] ,ＡＲＤＳ按 1992年欧美ＡＲＤＳ联席会议制订的标准[2 ] 。3 .治疗 :全部手术治疗。术中所见 :血性腹水量平均 10 0 0ｍｌ,全胰腺呈点片状坏死…     

预防性治疗重症急性胰腺炎合并肺损伤的体会

重症急性胰腺炎 ( severe acute pancreatitis,SAP)可以引起全身炎症性反应综合征 ( systemicinflammatory response syndrome,SIRS) ,并进一步出现包括肺、心、肝、肾及循环系统等损伤 ,甚至衰竭而至患者死亡 [1] 。这其中 ,急性呼吸窘迫综合征 ( a-cute respiratory distress syndrome,ARDS)是 SAP的主要并发症之一 ,其死亡率高达 5 0 % [2 ]。目前研究认为 ,ARDS患者肺部的损伤是持续炎症分子学机制[3 ] 。如何抑制过度炎症反应成为 ARDS预防性治疗关键。我们自 1 996年 2月～ 2 0 0 1年 1 2月采取乌司他丁 ( UTI)联合大剂量激…     

Restrictive Transfusion Practice During Extracorporeal Membrane Oxygenation Therapy for Severe Acute Respiratory Distress Syndrome

Recommendations concerning the management of hemoglobin levels and hematocrit in patients on extracorporeal membrane oxygenation (ECMO) still advise maintenance of a normal hematocrit. In contrast, current transfusion guidelines for critically ill patients support restrictive transfusion practice. We report on a series of patients receiving venovenous ECMO (vvECMO) for acute respiratory distress syndrome (ARDS) treated according to the restrictive transfusion regimen recommended for critically ill patients. We retrospectively analyzed 18 patients receiving vvECMO due to severe ARDS. Hemoglobin concentrations were kept between 7 and 9 g/dL with a transfusion trigger at 7 g/dL or when physiological transfusion triggers were apparent. We assessed baseline data, hospital mortality, time on ECMO, hemoglobin levels, hematocrit, quantities of packed red blood cells received, and lactate concentrations and compared survivors and nonsurvivors. The overall mortality of all patients on vvECMO was 38.9%. Mean hemoglobin concentration over all patients and ECMO days was 8.30 ± 0.51 g/dL, and hematocrit was 0.25 ± 0.01, with no difference between survivors and nonsurvivors. Mean numbers of given PRBCs showed a trend towards higher quantities in the group of nonsurvivors, but the difference was not significant (1.97 ± 1.47 vs. 0.96 ± 0.76 units; P = 0.07). Mean lactate clearance from the first to the third day was 45.4 ± 28.3%, with no significant difference between survivors and nonsurvivors (P = 0.19). In our cohort of patients treated with ECMO due to severe ARDS, the application of a restrictive transfusion protocol did not result in an increased mortality. Safety and feasibility of the application of a restrictive transfusion protocol in patients on ECMO must further be evaluated in randomized controlled trials.     

Extracorporeal Membrane Oxygenation for Refractory Severe Respiratory Failure in Acute Interstitial Pneumonia

Acute interstitial pneumonia (AIP) is a rare idiopathic interstitial lung disease with rapid progressive respiratory failure and high mortality. In the present report, three cases of AIP complicated by refractory respiratory failure supported with extracorporeal membrane oxygenation (ECMO) are presented. One male and two female patients (ages 27–59) were included. Venovenous ECMO support was provided using miniaturized systems, with two‐site femoro‐jugular circuit configuration. Despite lung protective ventilation, prone position and neuromuscular blockade, refractory respiratory failure of unknown etiology supervened (ratio of arterial oxygen partial pressure to fractional inspired oxygen 46–130) and ECMO was initiated after 3–7 days of mechanical ventilation. AIP diagnosis was established after exclusion of infectious and noninfectious acute respiratory distress syndrome on the basis of clinical and analytical data, bronchoalveolar lavage analysis and lung imaging, with a confirmatory surgical lung biopsy revealing diffuse alveolar damage of unknown etiology. Immunosuppressive treatment consisted in high‐dose corticosteroids and cyclophosphamide in one case. Two patients survived to hospital discharge. ECMO allowed AIP diagnosis and treatment in the presence of refractory respiratory failure, therefore reducing ventilator‐induced lung injury and bridging lung recovery in two patients. ECMO referral should be considered in refractory respiratory failure if AIP is suspected.     

Extracorporeal Membrane Oxygenation for Critically Ill Patients With 2009 Influenza A (H1N1)-Related Acute Respiratory Distress Syndrome: Preliminary Experience From a Single Center

From early May 2009, the novel influenza A (H1N1) pandemic affected mainland China. Of those infected, a small proportion of patients developed acute respiratory distress syndrome (ARDS) so rapidly and severely that conventional ventilation treatment was ineffective. As an alternative treatment, the effect of extracorporeal membrane oxygenation (ECMO) was evaluated. From November 2009 to January 2010, all patients suffering from influenza A (H1N1)‐associated ARDS referred to Beijing Anzhen Hospital for treatment with ECMO were enrolled. We describe the characteristics, treatment, and outcomes of these patients at 1‐ and 3‐month follow‐up. Nine patients (four females; mean age, 31.2 [21–59] years) from four centers were enrolled. All females had a history of recent pregnancy or had recently given birth. Before ECMO, patients had severe respiratory failure despite advanced mechanical ventilatory support with a mean partial pressure of arterial oxygen/fraction of inspired oxygen of 52.9 ± 5.1 (45.0–63.8) mm Hg, positive end‐expiratory pressure of 17.2 ± 4.2 cmH₂O, and a Murray Lung Score of 3.6 (3.25–3.75). All nine patients were treated with veno–venous ECMO via percutaneous access. The mean duration of ECMO support was 436.6 ± 652.1 h (67.0–2160.0). At the end of 1‐year follow‐up, five patients (55.7%) were weaned from ECMO. Five patients (55.7%) survived to hospital discharge. Four patients (44.4%) died while undergoing ECMO. The mean length of intensive care unit and hospital stay was 4–204 days (median, 32) and 4–234 days (median, 38), respectively. There was no significant difference between survivors and nonsurvivors in the screened parameters. Use of ECMO for critically ill patients with 2009 influenza A (H1N1)‐related ARDS is feasible and effective. However, this treatment is technically demanding. For success, careful selection of patients is crucial.     

Current Status of Extracorporeal Membrane Oxygenation for Severe Respiratory Failure

Abstract: Extracorporeal membrane oxygenation (ECMO) for respiratory failure was reviewed. ECMO progressed from laboratory research to initial clinical trials in 1972. Following a decade of clinical research, ECMO is now standard treatment for neonatal respiratory failure refractory to conventional pulmonary support techniques worldwide. The application of neonatal ECMO has been extended with improved outcome to premature and low birth weight infants as well as older children and adults. As of July 1994, 9,258 neonates, 754 pediatric, and 130 adult patients with respiratory failure treated with ECMO were entered in the registry of the Extracorporeal Life Support Organization (ELSO). Overall survival rates were 81% in neonates, 49% in pediatric, and 38% in adult patients. Recently the adult and pediatric populations treated with ECMO have increased rapidly, and the outcome has improved significantly.     

Comparison of a New Miniaturized Extracorporeal Membrane Oxygenation System With Integrated Rotary Blood Pump to a Standard System in a Porcine Model of Acute Lung Injury

Extracorporeal membrane oxygenation (ECMO) is used for severe acute respiratory distress syndrome. However, available ECMO systems are large and not well designed for fast delivery, emergency implantation, and interhospital transfer. Therefore, a new miniaturized oxygenator with integrated rotary blood pump (ILIAS) was developed and compared with a standard ECMO system in a large animal model. Acute lung injury was induced with repeated pulmonary saline lavage in 14 pigs until PaO₂/FiO₂‐ratio was <100 mm Hg with a positive‐end‐expiratory‐pressure of 5 mbar. Pigs were assigned to the following three groups: group 1 (n = 4): control group with conventional ventilation; group 2 (n = 5): standard vv‐ECMO; group 3 (n = 5): vv‐ILIAS. Gas exchange, hemodynamics, hemolysis, and coagulation activation were examined over a period of 8 h. No device failed during the observation period. PaCO₂ decreased from 59.40 ± 4.14 mm Hg to 48.62 ± 4.50 mm Hg after 1 h in the ILIAS group compared with an improvement of PaCO2 from 48.86 ± 7.45 to 40.10 ± 6.02 in the conventional ECMO group (P = not significant [n.s.]). ARDS‐induced respiratory acidosis was controlled promptly with a pH of 7.2 ± 0.1 at baseline increasing to 7.4 ± 0.1 in both study groups after 60 min of ECMO support. Mean carbon dioxide transfer was comparable between the conventional ECMO and ILIAS (211.36 ± 78.39 mL/min vs. 219.99 ± 76.72 mL/min, P = n.s.). PaO₂/FiO₂ increased from 118.4 ± 15.5 mm Hg to 179.1 ± 72.4 mm Hg in the ILIAS group compared with an improvement of oxygenation from 107.1 ± 24.9 mm Hg to 179.0 ± 45.7 mm Hg in the standard ECMO group (P = n.s.). Mean oxygen transfer was calculated with 136.09 ± 30.25 mL/min for the ILIAS and 129.05 ± 36.28 mL/min for the standard ECMO. Hemodynamic instability or significant activation of the plasmatic coagulation was not observed. However, hemolysis was significantly higher in the ILIAS group compared with the conventional ECMO. As the ILIAS prototype provided excellent gas exchange with hemodynamic stability comparable with a standard ECMO system, we believe this study serves as a proof of concept. Further development and design modifications (optimized rotation speed and surface coating of rotor) are already done and another experiment is projected to reduce hemolysis and platelet consumption for clinical application.     

Extracorporeal Membrane Oxygenation Support in Trauma Versus Nontrauma Patients with Noninfectious Acute Respiratory Failure

The utility of extracorporeal membrane oxygenation (ECMO) in patients with acute respiratory distress syndrome (ARDS) of noninfectious origin remains unclear. Data on patients with ARDS of noninfectious origin who underwent ECMO were reviewed retrospectively. We compared the pre‐ECMO characteristics and hospital outcomes of patients with traumatic and nontraumatic ARDS. In total, 23 patients (trauma, n = 9; nontrauma, n = 14) were included in the study. The mean patient age was 42 years, there were three females, and the mean pre‐ECMO Simplified Acute Physiologic Score (SAPS) II was 60.0 (49.0–71.0). The hemoglobin level was lower and the prothrombin time (PT) more prolonged, prior to initiation of ECMO, in traumatic compared with nontraumatic ARDS patients. During the first 48 h of ECMO support, the coagulation parameters did not differ between the two groups, but the platelet counts, PT, and activated partial thromboplastin time indicated that coagulopathy was developing in all patients. The hospital and 28‐day mortality rates were 21.7 and 13.0%, respectively, and serious neurological outcomes (cerebral performance category [CPC] of three points or more) developed in 26.1% of all patients; however, the extent of such outcomes did not differ between traumatic and nontraumatic ARDS patients. Upon multivariate analysis, the pre‐ECMO SAPS II tended to be associated with composite events (i.e., hospital death and/or a CPC of three points or more) (P = 0.051). Additionally, a history of hypertension and an elevated pre‐ECMO SAPS II were significant risk factors for serious neurological outcomes among hospital survivors (n = 18). In conclusion, ECMO support can be associated with favorable outcomes in patients with ARDS of noninfectious origin, irrespective of whether the ARDS is associated with trauma. The pre‐ECMO SAPS II and a history of hypertension may be independent risk factors for poor outcomes.     

Emergency Use of Extracorporeal Membrane Oxygenation in Cardiopulmonary Failure

Severe pulmonary and cardiopulmonary failure resistant to critical care treatment leads to hypoxemia and hypoxia-dependent organ failure. New treatment options for cardiopulmonary failure are necessary even for patients in outlying medical facilities. If these patients are in need of specialized center treatment, additional emergency medical service has to be carried out quick and safely. We describe our experiences with a pumpless extracorporeal lung assist (PECLA/iLA) for out-of-center emergency treatment of hypercapnic respiratory failure and the use of a newly developed hand-held extracorporeal membrane oxygenation (ECMO) system in cardiac, pulmonary, and cardiopulmonary failure (EMERGENCY-LIFE Support System, ELS System, MAQUET Cardiopulmonary AG, Hechingen, Germany). Between March 2000 and April 2009, we used the PECLA System (n = 20) and the ELS System (n = 33) in adult patients. Cannulation was employed using percutaneous vessel access. The new hand-held ELS System consists of a centrifugal pump and a membrane oxygenator, both mounted on a special holder system for storing on a standard patient gurney for air or ground ambulance transfer. Bedside cannulation processes were uneventful. The PECLA System resulted in sufficient CO₂ removal. In all ECMO patients, oxygen delivery and systemic blood flow could be restored and vasopressor support was markedly down. Hospital survival rate in the PECLA group was 50%, and 61% in the ECMO group. Out-of-center emergency treatment of hypercapnic pulmonary failure with pumpless extracorporeal gas exchange and treatment of cardiac, pulmonary, and cardiopulmonary failure with this new hand-held ECMO device is safe and highlyeffective. Patient outcome in cardiopulmonary organ failure could be improved.     

SAP继发腹内感染临床微生物学研究

目的:分析临床重症急性胰腺炎继发感染后细菌学特点。方法:采集2000年1月—2008年1月来源于天津市南开医院的符合重症急性胰腺炎标准的患者217例,统计分析符合重症急性胰腺炎,经腹腔渗液病原学培养及血培养阳性印证,继发腹内感染的42例患者的临床资料,分析继发感染后的微生物学特点。结果:继发感染主要发生在发病后2～3周内,时间主要集中在(17.30±1.95)d。感染患者中,革兰阴性合并革兰阳性菌感染23例,单纯革兰阴性菌感染13例,单纯革兰阳性菌感染4例,真菌感染2例。结论:继发感染多发生在发病后2～3周,时间主要集中在(17.30±1.95)d,以革兰阴性菌混合革兰阳性菌混合感染多见,菌株上以革兰阴性杆菌为主。