体外膜肺氧合技术抢救百草枯中毒的经验和教训  

Experience in application of extracorporeal membrane oxygenation technique for treating patients of paraquat intoxication

作　　者：许崇恩[1] 郭玲[2] 张涛[3] 范全心[1] 邹承伟[1] 王海石[4] 

机构地区：[1]山东大学附属省立医院心外科,济南250021 [2]山东大学附属省立医院心内科,济南250021 [3]山东省寿光市人民医院,寿光262700 [4]山东大学附属省立医院职业病科,济南250021

出　　处：《中国体外循环杂志》2012年第3期148-150,共3页Chinese Journal of Extracorporeal Circulation

摘　　要：目的总结体外膜肺氧合(ECMO)技术抢救2例百草枯中毒患者的经验教训。方法 1例中年女性患者采用右股静脉--右腋动脉(V-A)插管,另外1例青年男性患者采用右股静脉--右颈内静脉(V-V)插管,采用德国MAQUETRata Flow装置和血液管路套包进行ECMO支持。结果两位患者在ECMO期间患者神智清楚或间断镇静,前者不需呼吸机辅助支持(V-A),后者需要呼吸机支持(V-V)。中年女性患者因处于经期,ACT数值维持在120～160 s,ECMO 4天后发生脑栓塞继发脑出血,被迫中止ECMO治疗。青年男性患者ECMO支持10天,肺部发生条件致病菌感染和真菌感染,抗细菌和真菌感染治疗无效,放弃ECMO治疗。结论应遵循ECMO的使用指征,对于不可逆的肺部病变,尽量减少ECMO的应用,避免给患者和家属带来不必要的痛苦。Objective To evaluate the application of extracorpereal membrane oxygenation （ECMO） technique in treating patients of paraquat intoxication. Methods By using MAQUET Rata Flow equipment and circuits, ECMO was set up via right auxiliary artery and right femoral vein on a middle - aged woman, and via right jugular vein and right femoral vein on a young boy. Results The female patient was conscious or sedative during ECMO without mechanic support of the respirator, and the male patient was give the mechanic support of the respirator. For the middle - aged woman, due to being in the menstrual period, ACT was maintained at level of 120 -160 seconds. Cerebral hemorrhage secondary to cerebral embolism occurred four days later, and ECMO was forced to stop. For the young case, after ECMO support of ten days, infection from opportunistic pathogens and fungi occurred in the lung, and antibacterial and antifungal therapy were ineffective. So ECMO for this young ease was cancelled at the end. Conclusion Indication for application of ECMO should be as follows： for the irreversibly pulmonary lesion, ECMO support should not be applied.

关 键 词：体外膜肺氧合 百草枯中毒 插管 

分 类 号：R595.4[医药卫生—内科学]