危重患者在体外膜肺氧合支持下院间转运的病例系列报道  

A case series report of extracorporeal membrane oxygenation support for interhospital transport to critically ill patients

作　　者：张世新 夏梅 吴蔚 何萍 唐令凤 陈娅 廖云姝 陈巧 ZHANG Shixin;XIA Mei;WU Wei;HE Ping;TANG Lingfeng;CHEN Ya;LIAO Yunshu;CHEN Qiao(Department of Thoracic Surgery,First Affiliated Hospital,Army Medical University (Third Military Medical University),Chongqing,400038,China;Department of Cardiac Surgery,First Affiliated Hospital,Army Medical University (Third Military Medical University),Chongqing,400038,China)

机构地区：[1]陆军军医大学(第三军医大学)第一附属医院胸科,重庆400038 [2]陆军军医大学(第三军医大学)第一附属医院心外科,重庆400038

出　　处：《第三军医大学学报》2019年第1期13-18,共6页Journal of Third Military Medical University

基　　金：西南医院军事医学重大领域技术创新计划重点项目(SWH2017ZDCX2002)~~

摘　　要：目的总结我院体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)团队对10例外院危重患者实施ECMO支持下院间转运的临床结果和经验。方法收集2016年6月至2018年1月我院ECMO团队对10例外院危重患者实施ECMO支持下院间转运的临床资料,对患者的转运距离、转运并发症及治疗结果进行总结。结果 10例ECMO患者的转运距离为3. 4～248. 0 km,平均72. 6 km。转运过程中1例静脉-静脉(V-V) ECMO患者静脉管道扭曲,影响ECMO流量;2例静脉-动脉(V-A)ECMO患者切口渗血。10例患者都安全到达我院。1例患者治愈出院;1例患者成功撤除ECMO,后因肺部感染、多器官功能衰竭死亡;1例患者死亡;2例患者家属最后放弃治疗,自动出院;另外5例供体均成功获取肝脏和(或)肾脏。结论在ECMO支持下院间转运危重患者可以安全地进行,并发症可控;相关人员应重视ECMO多学科团队建设并规范操作流程。Objective To summerize the clinical outcomes and experience of extracorporeal membrane oxygenation (ECMO)supported inter-hospital transport for critically ill patients. Methods Clinical data of 10 critically ill patients undergoing ECMO-supported inter-hospital transport by our ECMO team during June 2016 and January 2018 were collected in this study. The transport distance, transport complications and treatment outcomes were summarized. Results The transport distance of 10 cases was 3.4 to 248.0 km, at an average of 72.6 km. During the transportation, 1 case of V-V ECMO patients (drainage from the right femoral vein and reflux to the right internal jugular vein) had twist of venous tubes, which affected ECMO flow, and 2 cases of V-A ECMO patients (drainage from the right femoral vein and reflux to the right femoral artery) had incision bleeding. All of the 10 cases safely reached our hospital. One patient was cured and discharged, 1 was successfully removed from ECMO but died of pulmonary infection and multiple organ failure, 1 patient died, 2 patients discharged from hospital by themselves because their family finally gave up the treatment, and the left 5 patients became brain death donors for the liver and/or kidneys. Conclusion Inter-hospital transport on ECMO can be safely performed in critically ill patients, and the complications associated with ECMO transport can be controlled. The staffs involved should pay attention to the construction of ECMO multidisciplinary team and standardize the operating procedures.

关 键 词：体外膜肺氧合 体外生命支持系统 院间转运 危重患者 

分 类 号：R459.7[医药卫生—急诊医学] R654.1[医药卫生—治疗学]