体外膜肺氧合在肺移植前支持过渡中的应用  被引量:7

Application of extracorporeal membrane oxygenation as a bridge to lung transplantation

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作  者:毛文君[1] 陈静瑜[1] 

机构地区:[1]南京医科大学附属无锡市人民医院肺移植中心,江苏214023

出  处:《器官移植》2011年第4期209-212,236,共5页Organ Transplantation

基  金:国家十一五科技支撑计划(2008BAI160B05)

摘  要:目的探讨体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)在肺移植前支持过渡中应用的可行性和疗效。方法终末期肺病患者5例,原发病为特发性肺间质纤维化3例,结核性毁损肺1例,淹溺致吸入性肺炎合并急性呼吸窘迫综合征(ARDS)1例。药物治疗和呼吸机无法纠正呼吸衰竭,紧急行ECMO,等待肺移植。5例患者均经股动脉-股静脉插管,根据体重、血流动力学情况及血气分析结果,调整ECMO流量。过渡期间能获得供体者行肺移植。结果经ECMO支持后,5例患者肺动脉压明显下降,氧合功能改善,其中例1、例2、例3成功过渡到肺移植,手术方式分别为双肺移植、右肺移植、右肺移植。例1、例2术后分别转流552 h和240 h,最终因严重并发症死亡;例3术后脱离ECMO,恢复良好,康复出院,现已存活1年半。例4于ECMO转流205 h后脱离ECMO,脱离7 d后死于脑部侵袭性真菌感染伴颅内出血;例5于ECMO转流160 h,死于多器官功能衰竭。结论在等待肺移植过程中,采用ECMO作为支持过渡措施是可行的,具有一定的临床应用价值。Objective To investigate the feasibility and efficacy of extracorporeal membrane oxygenation(ECMO)as a bridge to lung transplantation.Methods Five cases with pulmonary disease at final stage were selected.There were three cases of idiopathic pulmonary fibrosis(IPF),one case of damaged pulmonary tuberculosis,one diagnosed as aspiration pneumonia due to drowning combined with acute respiratory distress syndrome(ARDS).ECMO was implemented as supportive treatment and the catheters of ECMO devices were inserted via the femoral artery and vein.According to the hemodynamic condition and blood gas analysis results,the blood flow of ECMO was adjusted ranging from 2-3 L/min with excellent oxygenation index(350-420 mmHg,10 mmHg=1.33 kPa).The patients,who were successfully supported with ECMO,underwent lung transplantation.Results With the assistance of ECMO,pulmonary arterial pressure of 5 patients decreased and oxygenation function was improved.Case 1-3 successfully underwent lung transplantation under EMCO support,and bilateral,single right and single right lung transplantation were performed on them respectively.Case 1 and case 2 died of severe complications after prolonged use of ECMO for 552 h and 240 h after transplantation respectively.Case 3 was successfully weaned from ECMO after lung transplantation.He was discharged from hospital uneventfully and had survived for 1.5 years.Case 4 was weaned off ECMO at 205 h after circulation support,but died of invasive cerebral fungal infection and intracranial hemorrhage 7 days later.Case 5 died of multiorgan dysfunction syndrome(MODS)at 160 h after ECMO.Conclusion It is feasible and available to use ECMO,a life-saving intervention,as a life support bridge to lung transplantation.

关 键 词:肺移植 体外膜肺氧合 体外循环 

分 类 号:R459.6[医药卫生—治疗学]

 

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