ECMO在新型冠状病毒肺炎危重症患者中应用价值的探讨

新型冠状病毒肺炎（COVID-19）在中国武汉地区流行并蔓延，具有传染性强，重症患者病死率高的特点，部分重症患者出现呼吸、循环功能衰竭，严重威胁生命健康。在针对新型冠状病毒尚无特效药物情况下，体外膜肺氧合技术（ECMO）可以同时进行呼吸和循环功能支持，为危重患者救治赢得时间。本文将对ECMO在COVID-19重症患者中应用价值进行探讨。     

体外膜肺氧合在心脏外科围手术期治疗中的应用

目的：探讨体外膜肺氧合心脏手术围手术期的临床应用效果。方法：回顾性分析2010年1月至2021年4月无锡市人民医院心脏外科救治的因心脏围手术期心肺功能性衰竭而运用体外膜肺氧合（ECMO）治疗的32例患者临床资料,分析ECMO治疗的有效性及安全性。结果：18例患者成功脱离ECMO,14例恢复良好,顺利出院,4例患者因相关并发症死亡。14例患者无法撤除ECMO死亡。结论：ECMO能为心脏围手术期出现心肺功能衰竭的患者提供有效的循环呼吸支持,可行有效。     

体外膜肺氧合技术在儿科急性呼吸衰竭中的应用进展

［摘要］　体外膜肺氧合(ECMO)对严重心肺功能衰竭的患者可提供强有力的循环和呼吸支持,同时也是心肺功能衰竭患者等待心肺移植期间歇期的主要体外生命支持手段。已有大量的循证医学证据肯定了ECMO在儿童急性呼吸窘迫综合征(PARDS)中的救治作用,但在其他原因导致的急性呼吸衰竭中的应用报道较少,该文就目前ECMO在儿科急性呼吸衰竭中的应用进展作一综述。     

体外膜氧合辅助下救治严重气道阻塞2例报告及文献复习

<正>体外膜氧合(extracorporeal membrane oxygenation,ECMO)主要适用于严重急性心肺功能衰竭患者的支持治疗。因为强大呼吸循环支持功能和建立快捷、安全性高的优势,针对严重、紧急气道阻塞患者短期应用ECMO,能迅速控制病情,缓解呼吸衰竭,为原发病诊治争取时间。我院ICU运用ECMO技术辅助治疗2例恶性肿瘤引起的重症气道阻塞患者,均快速解除梗阻,挽救生命,效果满意。结合相关文献     

体外膜肺氧合在室间隔修补术后室性心动过速治疗中的应用

<正>体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)是一种持续体外生命支持手段,因其能有效维持机体心肺功能,亦称为体外生命支持系统(extra-corporeal life support,ECLS),主要用于严重呼吸功能衰竭和心源性休克的呼吸和循环支持治疗。现将我院应用ECMO成功救治室间隔修补术后室性心动过速(ventricular tachycardia,     

体外膜肺氧合辅助经皮冠状动脉介入治疗极高危急性冠状动脉综合征患者5例

正体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)是将血液从体内引到体外,经膜肺氧合后再用血泵或体外循环机将血液灌入体内,对一些呼吸或循环衰竭的患者进行有效支持的技术,它可使心肺得到充分的休息,为心功能和肺功能的恢复赢得宝贵的时间。本研究的目的在于评价ECMO辅助经皮冠状动脉介入治疗(percutaneous     

急性呼吸窘迫综合征与体外膜肺氧合技术进展

体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)技术是应用体外循环技术为新生儿、儿童及成人呼吸和(或)循环衰竭患者进行较长时间生命支持的技术。ECMO技术呼吸支持的价     

体外膜肺氧合临床应用现状及并发症防治

体外膜肺氧合（Extracorporeal Membrane Oxygenation,ECMO）是一种体外生命支持技术,根据置管方法的不同可分为静脉-静脉体外氧合和静脉-动脉体外氧合两种工作模式。ECMO可为呼吸衰竭、心力衰竭或心肺同时衰竭的患者提供临时生命支持(通常数天至数周)。ECMO相关的并发症仍是限制其临床疗效的重要因素。现将ECMO的应用现状和可能出现的并发症及其防治方法综述如下。     

体外膜肺氧合治疗心脏手术后急性心功能衰竭的疗效

目的总结体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)治疗心脏外科术后出现严重心功能衰竭的应用经验。方法选择自2009年10月至2013年2月在中山市人民医院进行心脏外科手术,且术后出现急性心功能衰竭而应用ECMO治疗的22例患者为研究对象,总结其应用ECMO治疗的临床情况。结果上机维持时间为(100.0±89.2)h。因心脏功能无法恢复,无法撤机并死亡4例;成功撤机18例,其中4例顺利撤机,但仍最终死亡;顺利恢复并出院14例。辅助过程中主要并发症为出血和感染。结论 ECMO的应用有利于辅助心肺功能和防治并发症,对于心脏术后心功能衰竭的治疗疗效肯定。     

体外膜肺氧合支持下重症患者的呼吸介入治疗

部分重症患者的呼吸介入治疗在常规局麻或全麻下风险极高,体外膜肺氧合（ECMO）可以提供有效的呼吸和（或）循环支持,预防或克服围手术期致命的低氧血症和高碳酸血症,保障手术顺利进行。文章结合目前发表的短期ECMO支持下重症患者呼吸介入治疗的病例报道,针对ECMO支持下呼吸介入治疗的应用时机、适用人群和ECMO管理细节（如工作模式、抗凝治疗、撤机和并发症等）等方面进行概述和探讨,以期能为更好开展ECMO支持下呼吸介入治疗提供指导。     

Two-step hepatectomy with right portal branch ligature for a right lobe metastasis

AIMS/BACKGROUND: Hepatic resection is the only treatment with possible curative effect both for primary and secondary tumors. An increase of the rate of resectability for tumors considered inoperable at first and a decrease of the postoperative morbidity and mortality can be realized by right portal branch ligature and two-step hepatectomy. METHODOLOGY: This paper presents the case of a patient with left bowel cancer with a hepatic metastasis. A right portal branch ligature was performed followed by systemic postoperative chemotherapy. RESULTS: The right portal branch occlusion was followed by right lobe atrophy and left lobe hypertrophy, confirmed by CT scan. Three months after the portal occlusion a right lobe hepatectomy was performed. The postoperative evolution was favorable; eight days of hospitalization were necessary. CONCLUSIONS: Portal branch ligature can be performed in certain cases of hepatic tumors to increase the resectability rate.     

Two-step hepatectomy with right portal branch ligature for a right lobe metastasis

Hepatic resection is the only treatment with possible curative effect both for primary and secondary tumors. An increase of the rate of resectability for tumors considered inoperable at first, and a decrease of the postoperative morbidity and mortality can be realized by right portal branch ligature and two-step hepatectomy. We would like to present the case of a patient with left bowel cancer with a hepatic metastasis. Right portal branch ligature was performed which was followed by systemic postoperative chemotherapy. The right portal branch occlusion was followed by right lobe atrophy and left lobe hypertrophy, confirmed by CT scanning. Three months after the portal occlusion the patient underwent a right lobe hepatectomy. The postoperative evolution was favorable, eight days of hospitalization were necessary. The portal branch ligature can be made in several cases of hepatic tumors to increase the resectability rate.     

Double-outlet right ventricle with origin of right pulmonary artery from a right-sided ductus arteriosus

A patient with double-outlet right ventricle is reported with the heretofore unreported association of a right pulmonary artery arising from a persistent right ductus arteriosus. The patient also had an infracrista ventricular septal defect, a secundum atrial septal defect, severe bicuspid valvular pulmonary stenosis, and a right-sided aortic arch.     

A comparison of right posterior sectorectomy with formal right hepatectomy: a dual-institution study

Objectives

Right posterior sectorectomy (RPS) preserves liver volume but typically requires a longer parenchymal transection distance than does right hepatectomy (RH). This study was conducted to define the advantages of one approach over the other.

Methods

Databases at two institutions were retrospectively reviewed for all patients submitted to RPS or RH between January 2000 and August 2012. Primary outcomes were perioperative complications and 90-day mortality.

Results

Patients undergoing RPS (n = 100) and RH (n = 480), respectively, were similar in demographics, comorbidities, operative indications and Model for End-stage Liver Disease (MELD) mean scores (7.8 in the RPS group and 7.7 in the RH group; P = 0.49). A comparison of the RPS group with the RH group showed no significant differences in mean estimated blood loss (697 ml versus 713 ml; P = 0.900), rate of transfusions (19.2% versus 17.1%; P = 0.720), margin-positive resection (9.2% versus 11.6%; P = 0.70), complications (41.8% versus 42.0%; P = 1.000), bile leak (3.0% versus 4.0%; P = 1.000), or length of stay (7.5 days versus 8.3 days; P = 0.360). Postoperative hepatic insufficiency (defined as a postoperative bilirubin level of >7 mg/dl or significant ascites), occurred less frequently after RPS (1.0% versus 8.5%; P = 0.005). Operation type remained an independent determinant of postoperative hepatic insufficiency after controlling for preoperative risk factors (RH: hazard ratio = 9.628, 95% confidence interval 1.295–71.573; P = 0.027). A total of 28 (4.8%) patients died within 90 days; these included 25 (5.2%) patients in the RH group and three (3.0%) in the RPS group (P = 0.449).

Conclusions

Despite similar blood loss and overall morbidity, RPS is associated with less hepatic insufficiency than RH. Right posterior sectorectomy is parenchyma-sparing and should be strongly considered when it is technically feasible and oncologically sound.     

Evaluation of right ventricular performance with a right ventricular ejection fraction thermodilution catheter and MRI in patients with pulmonary hypertension

STUDY OBJECTIVES: We sought to compare catheter studies using a right ventricular ejection fraction (REF) catheter together with echocardiography and MRI in patients with pulmonary hypertension. Patients and methods: We compared hemodynamic findings, echocardiography, and MRI studies in 16 patients with pulmonary hypertension. Six healthy volunteers served as control subjects for the MRI studies. RESULTS: MRI imaging provided accurate assessment of cardiac output in all but two patients. As compared with MRI, the REF catheter constantly underestimated the REF and overestimated right ventricular volumes in patients with pulmonary hypertension. REF, end-systolic and end-diastolic right ventricular volumes, and right ventricular muscle mass, as determined by MRI, were almost identical in patients with preserved cardiac function and those with low-output failure. The only factor that was different in both groups was the severity of tricuspid regurgitation. CONCLUSION: Right ventricular dimensions and muscle mass do not differ in patients with pulmonary hypertension who have low cardiac output and those who do not. According to our results, the major determinant of cardiac output in these patients appears to be the severity of tricuspid regurgitation. The REF catheter provides invalid data on right ventricular dimensions in patients with pulmonary hypertension.     

Implantation of a right heart assist device without a heart-lung machine in a patient with an acontractile right ventricle and HIT Type II

A simple surgical technique to insert an RVAD without the use of a heart-lung machine and without full anticoagulation is described here.