体外膜肺氧合在肺移植麻醉中的应用

目的 总结肺移植麻醉中体外膜肺氧合(extracorporeal memberane oxygenation,ECMO)辅助的适应证及术中运用ECMO支持的经验.方法 58例终末期肺病患者在麻醉诱导气管插管后,常规给予非术侧单肺通气30 min,监测肺动脉压(PAP)、氧分压(PaO2)、二氧化碳分压(PaCO2)、肺泡气·动脉氧分压差(PA-aO2)和呼吸力学等指标,根据监测指标调节机械通气参数,必要时行手控通气.17例患者分别因肺动脉高压、低氧血症和高碳酸血症而给予ECMO辅助,转流期间维持激活凝血时间(ACT)160秒～200秒,流量控制在1.8 L·m-2·min-1～2.5 L·m-2·min-1.结果 所有患者ECMO转流后PAP及PaCO:下降明显,氧合改善.麻醉伞程生命体征平稳.手术经过顺利.结论 ECMO是肺移植术中肺辅助的有效手段,可提高肺移植手术的麻醉成功率.原发性肺动脉高压、肺纤维化合并肺动脉高压、严重的低氧血症和高碳酸血症是肺移植术中ECMO转流的适应证.

Application of extracorporeal membrane oxygenation in lung transplantation

Objective To summarize the indication and experience of extraeorpomal membrane oxvgenation (ECMO)in lung transplantation,Methods Fifty eisht patients were undergone single non-operating lung ventilation for 30 min.Pulmonaryartery pressure,oxygen partial pressure,carbon dioxide partial pressure,PA-aO2 and pulmonary mechanics were monitored.Among 58 patients,17 patients were applied for ECMO due to pulmonary artery hypertension,hypoxemia and hypercapnia.ACT vital signs were stable,PAP and PaCO2 decreased obviously(P<0.05),and oxygenation improved(P<0.05)during suryery for patients with ECMO assistant. Conclusion ECMO is an effective assistant method to enhance the succes8 rate of 1ung trans-plantation.The indications of using ECMO assistant in lung transplantation include primary pulmonary hypertension,pulmonary fibrosis complicating pulmonary artery hypertension,severe hypoxemia and hypercapnia.