采用体外膜肺氧合技术治疗对重症急性呼吸窘迫综合征的疗效及影响因素分析  

The clinical efficacy and analysis of extracorporeal membrane oxygenation for adult severe acute respiratorydistress syndrome

作　　者：黄羽[1] 王春艳[1] 查渝[1] 童飞 曹晓光[1] 王润泽 周树生[1] 

机构地区：[1]安徽省立医院重症医学科,安徽省合肥230001

出　　处：《中国基层医药》2017年第24期3719-3723,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的 探讨静脉静脉体外膜肺氧合（ＶＶＥＣＭＯ）治疗重症急性呼吸窘迫综合征（ＡＲＤＳ）患者 的临床疗效，并对其相关因素进行分析。方法 采用回顾性分析方法，共纳入２２例重度ＡＲＤＳ患者，其中 ＥＣＭＯ组为采用ＥＣＭＯ技术治疗的８例重症ＡＲＤＳ患者，均采用ＶＶＥＣＭＯ方式，收集资料包括患者一般资 料，ＥＣＭＯ运行前后血气分析、血流动力学、机械通气参数以及ＥＣＭＯ辅助并发症等。对照组为未开展ＥＣＭＯ 技术以前治疗的１４例重症ＡＲＤＳ患者，同样采集患者一般资料，治疗期间的血气分析、血流动力学以及机械 通气参数等数据。结果 在该研究中，共有８例重症ＡＲＤＳ接受ＥＣＭＯ治疗，男性５例，女性３例，平均年龄 （４６．３±１４．１）岁。与对照组相应时间比较，在应用ＥＣＭＯ治疗后２４ｈ，ＥＣＭＯ组各项指标除平均动脉压（ｔ＝ －０．８７２，Ｐ＝０．３５７）之外：呼吸频率（ｔ＝－１．６７０，Ｐ＝０．０３４）、心率（ｔ＝－１．９７３，Ｐ＝０．０４２）、ｐＨ（ｔ＝－１．４３２， Ｐ＝０．０３３）、二氧化碳分压（ｔ＝－２．５６４，Ｐ＝０．０２４）、氧分压（ｔ＝－４．９５５，Ｐ＜０．００１）、氧合指数（ｔ＝－３．６５４， Ｐ＜０．０１）、ＰＥＥＰ（ｔ＝－１．３８２，Ｐ＝０．０３１）、Ｐｐｌａｔｅａｕ（ｔ＝－２．７８５，Ｐ＜０．０１）、血乳酸（ｔ＝－２．５６４，Ｐ＝０．０２４）均 显著改善。另外两组间比较在入住ＩＣＵ时间（ｔ＝－２．４５２，Ｐ＝０．０２７）、总机械通气时间（ｔ＝－１．４７８，Ｐ＝ ００３８）、器官功能衰竭数目（ｔ＝１．９６３，Ｐ＝０．０４７）、住院病死率（ｔ＝－１�Objective To investigate the clinical experience and associated factors of extracorporeal mem- brane oxygenation（ECMO）for adult patients with severe acute respiratory distress syndrome（ARDS）. Methods The clinical data of 22 adult patients with severe ARDS, which met the criteria for ECMO, were retrospectively collected and analyzed. The ECMO team all receiving VV-ECMO treatment （Veno-venous extracorporeal membrane oxygena- tion）, data collection including the patients, general data, blood gas analysis, hemodynamics, mechanical ventilation parameter before and after the ECMO treatment and the auxiliary complications, etc. The control group were 14 cases of patients with severe ARDS which receiving conventional treatment; We collected the same data as the research team. Results In the research,8 patients treated with YV-ECMO, There were 5 males and 3 females, with an average age of （46.3 ± 14.1 ）years. Compared with the factors at the same time point in the control group, those of the ECMO group, except MAP （ t = - 0.872,P = 0. 357）, Respiratory rate （ t = - 1. 670, P = 0.357）, Heart rate （ t = - 1. 973, P = 0.042 ）, PH （ t = - 1. 432, P = 0.033 ）, PaCO2 （ t -- - 2. 564, P = 0. 024 ）, PO2 （ t = - 4. 955, P 〈 0. 001 ）, PO2/FiO2 （t = - 3. 654 ,P 〈 0.01 ）, PEEP （ t = - 1. 382, P = 0. 031 ）, Pplateau （ t = - 2. 785, P 〈 0.01 ）, Blood lactate （ t = - 2. 564, P = 0. 024 ） were significantly improved after ECMO running 24 hours （ all P 〈 0.05 ）. And also the factorssuch as the length of ICU stay （ t = - 2. 452, P = 0. 027 ）, the times of mechanical ventilation （ t = - 1. 478, P = 0. 038 ）, number of organ failure （ t = - 1. 963, P = 0. 047 ）, the hospital mortality rates （ t = - 1. 970, P = 0.045 ） and treatment costs（t = -1. 667 ,P = 0.035） between the ECMO group and the control group were significantly different （ P 〈 0.05 ）. In the end, we divided the ECMO group into survival group and death group, and compare the time of Mec

关 键 词：呼吸窘迫综合征 成人 通气机机械 体外膜式肺氧合 

分 类 号：R563.8[医药卫生—呼吸系统]