体外膜肺氧合在肺移植麻醉中的应用  

Application of extracorporeal membrane oxygenation in lung transplantation

作　　者：胡春晓[1] 胡毅平[1] 张建余[1] 曾因明[3] 陈静瑜[2] 王雁娟[1] 郑明峰[2] 

机构地区：[1]南京医科大学附属无锡市人民医院麻醉科,214023 [2]南京医科大学附属无锡市人民医院胸外科 [3]徐州医学院江苏省麻醉医学研究所

出　　处：《国际麻醉学与复苏杂志》2009年第2期103-105,共3页International Journal of Anesthesiology and Resuscitation

基　　金：国家卫生部科技发展基金重大课题资助项目（WKJ2004-2-008）

摘　　要：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30min，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1．8L·m^-2·min^-1～2．5L·m^-2·min^-1。结果所有患者ECMO转流后PAP及PaCO2下降明显，氧合改善。麻醉全程生命体征平稳，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。原发胜肺动脉高压、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。Objective To summarize the indication and experience of extracorporeal membrane oxygenation （ECMO）in lung transplantation. Methods Fifty eight patients were undergone single non-operating lung ventilation for 30 min. Pulmonary artery pressure, oxygen partial pressure, carbon dioxide partial pressure, PA-aO2 and pulmonary mechanics were monitored. A- mong 58 patients, 17 patients were applied for ECMO due to pulmonary artery hypertension, hypoxemia and hypercapnia. ACT was maintained at 160 s-200 s, bypass flow controlled at 1.8L·m^-2·min^-1-2.5 L·m^-2·min^-1 during ECMO. Results All of the vital signs were stable, PAP and PaCO2 decreased obviously （P〈0.05）, and oxygenation improved （P〈0.05）during surgery for patients with ECMO assistant. Conclusion ECMO is an effective assistant method to enhance the success rate of lung transplantation. The indications of using ECMO assistant in lung transplantation include primary pulmonary hypertension, pulmonary fibrosis complicating pulmonary artery hypertension, severe hypoxemia and hypercapnia.

关 键 词：肺移植 麻醉 体外膜肺氧合 

分 类 号：R614[医药卫生—麻醉学]