ECMO在肺移植患者术前过渡中的应用  

Extracorporeal membrane oxygenation as a bridge to lung transplantation

作　　者：夏维[1] 许红阳[1] 毛文君[2] 陈静瑜[2] Xia Wei;Xu Hongyang;Mao Wenjun;Chen Jingyu(Department of lntensive Care Unit,Affiliated Wuxi People's Hospital,Nanjing Medical University,Wuxi 214023,Jiangsu, China;Department of Thoracic Surgery,Affiliated Wuxi People's Hospital,Nanjing Medical University, Wuxi 214023,Jiangsu,China)

机构地区：[1]南京医科大学附属无锡市人民医院重症医学科,江苏无锡214023 [2]南京医科大学附属无锡市人民医院胸外科,江苏无锡214023

出　　处：《中华危重病急救医学》2018年第12期1167-1172,共6页Chinese Critical Care Medicine

基　　金：江苏省科教强卫工程青年医学重点人才项目(QNRC2016193).

摘　　要：目的探讨体外膜肺氧合(ECMO)用于肺移植患者术前过渡的有效性。方法回顾性分析南京医科大学附属无锡市人民医院心肺诊疗中心2015年1月至2017年12月收治的18例接受ECMO过渡的肺移植手术患者的临床资料,包括性别、年龄、原发病、围手术期乳酸、术前白细胞、手术方式(单肺或双肺)、ECMO支持方式、ECMO过渡时间、术后ECMO使用时间、ECMO总使用时间、ECMO并发症、术后原发性移植物失功(PGD)、撤除ECMO以及生存情况。根据ECMO支持方式、ECMO是否成功撤除或原发病将患者进行分组,比较两组临床资料,并绘制患者180dKaplan-Meier生存曲线。结果①整体情况显示:18例接受ECMO过渡至肺移植手术的患者中,男性14例,女性4例;年龄23~78岁;特发性肺纤维化(IPF)6例,特发性肺动脉高压(IPAH)3例,间质性肺炎8例,矽肺1例;静脉-静脉(V-V)ECMO方式9例,静脉-动脉(V-A)ECMO方式9例;ECMO成功过渡至手术15例,过渡失败3例;ECMO过渡时间中位数为57.5(14.5,116.5)h;ECMO相关并发症中出血6例,肾功能不全12例,血栓2例,氧合器渗漏2例,下肢缺血1例;手术方式中单肺移植7例(右肺5例、左肺2例),双肺移植8例;术前死亡3例,死亡原因均为感染性休克;术后死亡9例,死亡原因为感染性休克4例,多器官功能衰竭4例,心源性猝死1例;长期生存6例。②分组比较显示:V-VECMO组(7例)与V-AECMO组(8例)通过ECMO成功过渡至肺移植手术的患者在性别、年龄、术前ECMO过渡时间、术后ECMO使用时间、ECMO总使用时间、术后PGD发生率、ECMO撤机成功率和术后180d累积生存率方面差异均无统计学意义。ECMO成功撤除组(11例)与撤除失败组(7例)患者性别、年龄、原发病、ECMO支持方式、手术方式、术前白细胞差异均无统计学意义,但成功撤除组较撤除失败组围手术期乳酸水平低(mmol/L:3.01±1.51比8.27±3.49,t=-3.770,P=0.006),ECMO总使用时间短(h:72.82±40.53比210.71±107.10,t=Objective To evaluate the effect of extracorporeal membrane oxygenation(ECMO)as a bridge to lung transplantation(LTx).Methods The clinical data of 18 patients with end-stage lung diseases was retrospectively reviewed,using ECMO as a bridge to LTx in intensive care unit of Affiliated Wuxi People's Hospital from January 2015 to December 2017.Clinical parameters were obtained from these patients,including gender,age,primary disease,preoperative lactate level,preoperative leukocyte,operation modality(unilateral or bilateral),type of ECMO,ECMO support time as a bridge to LTx,ECMO support time after operation,total usage time of ECMO,ECMO associated complications,primary graft dysfunction(PGD),successful ECMO weaning,and survival.Patients were divided according to type of ECMO,whether successfully weaned from ECMO or not,and primary disease.Clinical data was compared,and the Kaplan-Meier survival of 180-day was studied.Results ① The overall situation showed:A total of 18 patients were enrolled,with 14 males and 4 females,age ranged from 23 to 78 years old.Primary disease included 6 cases of idiopathic pulmonary fibrosis(IPF),3 cases of idiopathic pulmonary hypertension(IPAH),8 cases of interstitial pneumonia and 1 case of silicosis.Nine patients received venous-venous(V-V)ECMO and 9 venous-artery(V-A)ECMO as a bridge to LTx;15 patients received LTx successfully,and failed in 3 cases.The average bridge time was 57.5(14.5,116.5)hours.ECMO associated complications included 6 cases with bleeding,12 cases with renal failure,2 cases with thrombosis,2 cases with oxygenator leak,and 1 case with leg ischemia.There were 7 unilateral(5 right lungs and 2 left lungs)and 8 bilateral LTx.Three patients died before LTx due to septic shock.Nine patients died after LTx,4 for septic shock,4 for multiple organ failure,and 1 for sudden cardiac death.Six patients survived after LTx.② Group comparison showed:There was no significant difference in gender,age,ECMO support time as a bridge to LTx,ECMO support time after operation,total ECMO

关 键 词：肺移植 体外膜肺氧合 术前过渡 

分 类 号：R655.3[医药卫生—外科学]