体外膜肺氧合与传统机械通气在心肺辅助循环中疗效比较  

Comparative analysis of extracorporeal membrane oxygenation and mechanical ventilation for cardiopulmonary support

作　　者：刘欣伟[1] 柳云恩[2,3] 佟昌慈 赵科研[4] 高燕[2,3] 金红旭[2,3] 张玉彪[2,3] 刘颖[2,3] 刘学磊[2,3] 丛培芳[2,3] 侯明晓[2,3] 

机构地区：[1]沈阳军区总医院骨科,辽宁沈阳110016 [2]沈阳军区总医院急诊科,辽宁沈阳110016 [3]沈阳军区总医院全军重症(战)创伤救治中心实验室及辽宁省重症创伤和器官保护重点实验室,辽宁沈阳110016 [4]沈阳军区总医院心外科,辽宁沈阳110016

出　　处：《创伤与急危重病医学》2016年第1期15-20,共6页Trauma and Critical Care Medicine

基　　金：2012年辽宁省科技攻关(201122007);2012年全军"十二五"面上项目(CSY12J002);2013年全军"十二五"面上延续项目(CSY13J003)

摘　　要：目的探讨体外膜肺氧合(ECMO)与传统机械通气在心肺辅助循环中应用的疗效。方法选取沈阳军区总医院自2011年1月至2014年12月收治的严重创伤患者40例。按治疗方式不同分为机械通气治疗组30例,ECMO治疗组10例。监测所有患者生理、生化、血气分析、凝血等指标,并对两组患者临床疗效进行比较。结果机械通气治疗组患者18例出院,7例院内死亡,5例脱离机械通气呼吸困难。ECMO治疗组5例出院,2例院内死亡,3例脱离体外循环困难。两组患者治疗后,随着治疗时间的延长,患者心率、呼吸率、血压在48 h时明显低于24 h,病情持续好转;ECMO治疗组患者在心率、呼吸率、血压的下降幅度明显大于机械通气治疗组,差异有统计学意义(P<0.05)。两组患者白细胞计数(WBC)、红细胞计数(RBC)和血红蛋白浓度(HGB)在48 h时明显低于24 h,随着治疗时间的延长,病情持续好转;ECMO治疗患者的WBC、RBC和HGB下降幅度明显大于机械通气治疗组患者,差异有统计学意义(P<0.05)。ECMO治疗组的Pa CO_2、Pa O_2、Scv O_2明显高于机械通气治疗组,差异有统计学意义(P<0.05)。两组患者平均肺动脉压(MPAP)和肺毛细血管嵌顿压(PAWP)无明显变化。ECMO治疗组的平均动脉压(MAP)、右心房压(RAP)、右心室压(RVP)和心输出量(CO)明显低于机械通气治疗组,且治疗48 h时明显低于24 h,差异有统计学意义(P<0.05)。结论 ECMO的呼吸辅助功能为机体提供了良好的内环境,是一种重要的生命支持形式,具有广阔的应用前景。Objective Through comparing and analyzing the traditional mechanical ventilation and extracorporeal membrane oxygenation in lung injury,we try to find curative effect of the application of the auxiliary circulation of extracorporeal membrane oxygenation.Methods Between January 2011 and December 2011,a total of 40 cases of accident,mine blasting were hospitalized,40 patients were performed mechanical ventilation or ECMO support,28 cases were male and female 12 cases.30 cases（ 75%） were for installation of mechanical ventilation treatment after trauma,aged from 19 to 76,the average age were（ 34. 51±25. 17）.10 cases（ 25%） were for installation of the ECMO treatment after trauma,aged from 19 to76,the average age were（ 29. 98 ± 26. 31） years. Treatment and monitoring of physiological,biochemical,blood gas analysis and blood coagulation indexes were compared.Results The mechanical ventilation treatment group of 18 cases discharged from the hospital,7 cases were of in-hospital deaths,5 patients med took out mechanical ventilation breathing difficulties.10 cases of ECMO in patients were with severe trauma,5 cases（ 50%） were out of the hospital,2 cases died（ 20%） in the hospital.3 cases（ 30%） were out of extracorporeal circulation difficulties. Conclusion ECMO breathing auxiliary function provides the body with good internal environment. It is a kind of important form of life support and has broad application prospects.

关 键 词：体外膜肺氧合 机械通气 体外生命支持 心肺辅助循环 

分 类 号：R563.8[医药卫生—呼吸系统]