重症急性呼吸窘迫综合征体外膜肺治疗的探讨

目的 回顾性分析体外膜氧合(ECMO)在重症急性呼吸窘迫综合征(ARDS)治疗中的作用.方法 应用股静脉-股动脉途径的ECMO支持对1例吸入烟雾弹致严重ARDS患者治疗41 d.连续观察患者血液动力学、肺影像学、呼吸机参数、经皮脉氧氧饱和度、酸碱平衡、血乳酸含量以及心、肝、肾、脑功能的变化.结果 ECMO支持技术可使重症ARDS患者较长时间维持生理水平的动脉血气、组织氧供及酸碱平衡,保持良好的心、肺、肾、脑功能,但患者在行ECMO支持治疗的第41天因严重的肺部感染并可能的脑出血失去继续治疗的价值而终止治疗.结论 ECMO可提供有效的肺功能支持,可为ARDS患者肺的恢复和临床进一步处理创造了机会.出血与栓塞是维持ECMO顺利运行的关键问题.

Extracorporeal membrane oxygenation therapy for severe acute respiratory distress syndrome

Objective To analyze retrospectively the effects of extracorporeal membrane oxygenation (ECMO) on the therapy of severe acute respiratory distress syndrome (ARDS). Methods A patient with severe ARDS caused by smoking bomb was treated with veno-arterial ECMO for 41 days. The hemodynamics,lung imaging,mechanical ventilation parameters,percutaneous arterial oxygen saturation, acid-base balance, blood lactate, and heart, liver, kidney, brain function changes of the patients were observed continuously. Results The patient with severe ARDS treated with ECMO maintained physiological levels of arterial blood gas, tissue oxygen supply and acid-base balance for a long time,and kept good functions of heart,lung,kidney,brain. On the 41th day,the patient terminated treatment because of severe pulmonary infection and probable brain hemorrhage. Conclusions ECMO can provide effective support for lung function, give an opportunity for pulmonary rehabilitation of ARDS patients and further clinical treatment. Hemorrhage and thrombosis are the key problems of ECMO.