体外膜肺氧合支持在气道重建中的应用体会  

Airway Reconstruction supported by Extracorporeal Membrane Oxygenation

作　　者：蒲虹[1] 黄晓波[1] 黎嘉嘉[1] 黄江 余晓旭[3] 李祥奎[4] 

机构地区：[1]四川省人民医院重症医学科,四川成都610072 [2]珥川省人民医院呼吸内科,四川成都610072 [3]四川省人民医院耳鼻喉科,四川成都610072 [4]四川省人民医院麻醉科,四川成都610072

出　　处：《中国呼吸与危重监护杂志》2016年第2期161-165,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：四川省科技厅支撑项目(编号:2014sz0011)

摘　　要：目的探讨对于大气道梗阻或狭窄患者在常规通气无效情况下,体外膜肺氧合（ECMO）辅助下实施气道重建的可行性及安全性。方法气道肿瘤患者2例和气管狭窄伴气管瘘患者1例,在ECMO辅助下分别行支气管镜下肿瘤介入治疗、气管成型及气管半造瘘术等气道重建手术。结果术中氧合满意,对于气道梗阻或狭窄的病例在ECMO辅助下可为机体提供充足的氧合,为手术争取足够时间,结合气管重建手术,患者术后恢复良好。1例食道癌气管转移病例术后3个月随访因食道癌全身转移致多器官功能衰竭死亡;余2例随访均存活,气促分级为2~3级。结论对于无法建立常规通气的患者,ECMO可作为一种安全有效的辅助方法,需掌握适应证,加强管理,为进一步诊治赢得宝贵时间。Objective To explore the feasibility and safety of extracorporeal membrane oxygenation（ ECMO） to support the airway reconstruction for the patients with airway obstruction or stenosis who cannot be ventilated routinely. Methods There were 3 patients received trachea reconstruction procedures assisted by ECMO. Among the patients,2 cases with tracheal neoplasms underwent fibrobrochoscopy treatments,another one with endotracheal stenosis and fistula received tracheoplasty and semi-tracheostomy. Results ECMO can provide enough oxygenation for the patients with airway obstruction or stenosis and more time for advanced therapies. All three patients recovered after interventional surgeries,in whom one case died due to multiple organ failure caused by esophageal carcinoma metastasis after 3 months,and the others survived with dyspnea classification of 2-3 grade. Conclusion ECMO can be a safe and effective approch for the patients who cannot be ventilated conventionally in airway reconstruction.

关 键 词：体外膜肺氧合 气道重建术 气管肿瘤 气管狭窄 

分 类 号：R734[医药卫生—肿瘤]