不同病因导致急性呼吸窘迫综合征应用体外膜式氧合治疗体会

目的:观察不同病因引起急性呼吸窘迫综合征(ARDS)的患者,应用体外膜式氧合(ECMO)的治疗效果。方法:回顾性分析2007年6月至2008年8月我院3例ARDS应用ECMO病例。发生原因分别是重症肺炎、胸腹联合创伤后合并呼吸机相关性肺炎(VAP)、以及肺栓塞肺动脉内膜血栓剥脱术后灌注肺;观察应用ECMO前基础状态(Base)、用后8 h、24 h、48 h及72 h动脉血气分析、血压、脉搏和呼吸机调整参数。结果:应用ECMO后,例1重症肺炎患者8 h、24 h、48 h及72 h血压、脉搏及氧合等项指标平稳,但ECMO参数下调时,缺氧状态无缓解,最终ECMO辅助14 d后死亡;例2胸腹联合创伤后VAP合并ARDS患者和例3肺栓塞术后灌注肺患者,ECMO辅助8 h、24 h、48 h、72 h血压、脉搏、氧合等项指标明显改善,分别于ECMO辅助4 d后和24 h后停机。结论:不同病因导致的ARDS应用ECMO后可能结果有所不同。ECMO能改善ARDS患者氧合和气体交换,减轻肺部病理损伤,减轻机体因低氧血症带来的多器官损伤,为治疗原发病赢得时间。

Extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) in patients of different causes

Objective:To show the effectiveness of the extracorporeal membrane oxygenation(ECMO) in 3 cases of severe acute respiratory distress syndrome(ARDS) with different cause.Methods:During June 2007 to August 2008,3 cases with severe lung contusion were treated by ECMO in our hospital,the clinical data of them in pre-ECMO、post-ECMO 8h、24h、48h and 72h were analysised.Results:The times of ECMO support were 24 hours to 14 days.After instituted of ECMO,all of paitents’oxygenation improved initially,and the mechanical ventilator support down to low level.Two patients were stable in ABG,BP,Pulse and oxygenation,They survived after ECMO support 24 hours and 4 days,respectively.The other patient was death after ECMO 14d,Because his oxygenation was not improved.There were no ECMO-related complications such as thrombus,bleeding and hemolysis.Conclusion: The patients of ARDS with different causes could be difference results.ECMO can be improved rapidly gas exchange and provide sufficicnt oxygenation,reduce lung injury and organ failure.