体外膜肺氧合与机械通气用于严重急性呼吸窘迫综合征患者院间转运的对比研究  

Comparison of extracorporeal membrane oxygenation and mechanical ventilation for inter-hospital transport of severe acute respiratory distress syndrome patients

作　　者：徐磊[1] 王志勇[1] 李彤[2] 李智伯[1] 胡晓旻[2] 冯全胜[1] 段大为[2] 高心晶[1] 

机构地区：[1]天津市人工细胞重点实验室,天津市第三中心医院重症医学科,300170 [2]天津市第三中心医院心脏中心

出　　处：《中华危重病急救医学》2014年第11期789-793,共5页Chinese Critical Care Medicine

基　　金：天津市医药卫生重点攻关项目（12KG106）

摘　　要：目的：比较严重急性呼吸窘迫综合征（ARDS）患者应用体外膜肺氧合（ECMO）和常规机械通气进行院间转运的情况和临床结局，探讨严重ARDS患者最佳的院间转运方式。方法回顾性分析2009年11月至2014年1月因常规机械通气失败，从其他医院转诊到天津市第三中心医院的11例严重ARDS患者的临床资料。以5例应用ECMO辅助转运者为观察组，6例由移动呼吸机转运者为对照组。比较两组患者的临床特征和结局、转运情况以及转运前后生命体征、呼吸机参数和Murray评分。结果观察组年龄明显大于对照组〔岁：73（46，77）比34（23，46），Z＝-2.293，P＝0.022〕，转运前急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、Murray评分、氧合指数（PaO2/FiO2）以及转运时间、转运距离与对照组比较差异无统计学意义〔APACHEⅡ（分）：36（33，39）比27（23，35），Z＝-1.830，P＝0.067；Murray评分（分）：3.5±0.3比3.4±0.2， t＝0.667，P＝0.524；PaO2/FiO2（mmHg，1 mmHg＝0.133 kPa）：61±14比63±14，t＝-0.249，P＝0.809；转运时间（min）：24（18，74）比79（41，86），Z＝-1.654，P＝0.098；转运距离（km）：12.9（8.3，71.8）比72.4（39.5，86.8），Z＝-1.651，P＝0.099〕。两组转运前生命体征、呼吸机参数和Murray评分均无差异。观察组转入时心率、呼吸频率、吸入氧浓度、吸气压、Murray评分明显低于对照组〔心率（次/min）：102±16比136±8，t＝-4.374， P＝0.002；呼吸频率（次/min）：23±3比37±2，t＝-7.967，P＝0.000；吸入氧浓度：0.40±0.05比0.96±0.09， t＝-12.152，P＝0.000；吸气压（cmH2O，1 cmH2O＝0.098 kPa）：21±1比34±4，t＝-6.887，P＝0.000；Murray评分（分）：2.7±0.2比3.8±0.2，t＝-8.573，P＝0.000〕，而PaO2/FiO2明显高于对照组（mmHg：278±65比41±5， t＝8.075，P＝0.001）。观察组4例存活出院，1例转运途中出现氧气供应中�Objective To compare inter-hospital transport and clinical outcome in severe acute respiratory distress syndrome（ARDS）patients whom were transported either on extracorporeal membrane oxygenation（ECMO） or on conventional ventilation,and to investigate the optimal means of inter-hospital transport. Methods Eleven patients with severe ARDS who were invalid under conventional ventilation and were transported from other hospitals to Tianjin Third Central Hospital from November 2009 to January 2014 were analyzed. Five patients were transported on ECMO（observation group）and 6 on conventional ventilation（control group）. The clinical characteristics,outcomes, transportation,vital signs before and after transportation,respiratory parameters,and Murray score between two groups were compared. Results Patients in observation group were significantly older than those in control group〔years：73（46,77）vs. 34（23,46）,Z=-2.293,P=0.022〕. There was no significant difference between observation group and control group in acute pathologic and chronic health evaluationⅡ（APACHEⅡ）score,Murray score,oxygenation index（PaO2/FiO2）before transportation,transit time,and transit distance〔APACHEⅡscore：36（33,39）vs. 27（23,35）,Z=-1.830,P=0.067;Murray score：3.5±0.3 vs. 3.4±0.2,t=0.667,P=0.524;PaO2/FiO2（mmHg, 1 mmHg=0.133 kPa）：61±14 vs. 63±14,t=-0.249,P=0.809;transit time（minutes）：24（18,74）vs. 79（41, 86）,Z=-1.654,P=0.098;transit distance（km）：12.9（8.3,71.8）vs. 72.4（39.5,86.8）,Z=-1.651,P=0.099〕. There was no significant difference between two groups in vital signs and respiratory parameters before transportation. When arrived in ECMO centre,heart rate,respiratory rate,fractional inspired oxygen,inspiratory pressure and Murray score in observation group were significantly lower than those in control group〔heart rate（beat/min）：102±16 vs. 136±8, t=-4.374, P=0.002;respiratory rate（beat/min）：23±3 vs. 37±2,t=-7.967,P=0.000;fractional inspired oxy

关 键 词：严重急性呼吸窘迫综合征 体外膜肺氧合 医院间转运 

分 类 号：R563.8[医药卫生—呼吸系统]