ECMO在高脂血症重症急性胰腺炎合并重度ARDS救治中的应用  

Application of ECMO in the Treatment of Severe Acute Pancreatitis With Hyperlipidemia and Severe ARDS

作　　者：彭开毅[1] PENG Kaiyi(Department of Intensive Medicine, Maoming People＇s Hospital, Maoming Guangdong 525000, Chin)

机构地区：[1]广东省茂名市人民医院重症医学科,广东茂名525000

出　　处：《中国卫生标准管理》2018年第9期37-39,共3页China Health Standard Management

摘　　要：目的探讨ECMO在救治高脂血症重症急性胰腺炎合并重度ARDS中的临床疗效。方法 2016年3月—2018年3月选取5例由高脂血症导致的重症急性胰腺炎合并重度ARDS患者,在常规的呼吸机通气后仍难以纠正的严重低氧,予加用ECMO辅助治疗,对救治效果及治疗前后患者的Pa O2/Fi O2、血管外肺水(EVLW)变化情况进行观察。结果 5例患者中4例好转并顺利撤离ECMO,1例因感染性休克难以逆转而死亡;加用ECMO辅助治疗后患者的Pa O2/Fi O2提高,血管外肺水(EVLW)下降,在治疗1天后、治疗3天后、治疗7天后Pa O2/Fi O2指标水平能维持在较高水平,均较治疗前有差异,差异有统计学意义(P<0.05);且在治疗3天后、治疗7天后EVLW指标水平不断下降,差异有统计学意义(P<0.05)。结论 ECMO在高脂血症重症急性胰腺炎合并重度ARDS患者的救治中能够及时有效的提高患者的血氧浓度,使双肺渗出减少,让重度受损的肺部得到休息,提高了此类急性重症胰腺炎的抢救成功率。Objective To investigate the clinical effect of ECMO in the treatment of severe acute pancreatitis with hyperlipidemia and severe ARDS. Methods From March 2016 to March 2018, five cases of severe acute pancreatitis complicated with severe ARDS caused by hyperlipidemia were selected and treated with ECMO adjuvant therapy, which was still difficult to correct after routine ventilator ventilation and then ECMO was applied as adjunctive theapy. The efect of treatment and the changes of PaO2/FiO2 and extravascular lung water （EVLW） before and after treatment were observed. Results 4 out of 5 patients were better and successfully evacuated from ECMO, 1 patient died due to septic shock. The level of PaO2/FiO2 of the patients with adjunctive therapy of ECMOwas signifcantly increased, EVLW decreased obviously, and the level of PaO2/FiO2 maintained at a higher level after 1 day, 3 days and 7 days after treatment. There was significant difference than those before treatment （P 〈 0.05）, and after 3 days and 7 days of treatment, the level of EVLW decreased continuousl, and the diference was statistically signifcant （P 〈 0.05）. Conclusion The treatment of ECMO in patients with severe acute pancreatitis with hyperlipidemia and severe ARDS, can improve the blood oxygen concentration of the patients in time and effectively, reduce the exudation of both lungs obviously, let the severely damaged lung get rest, and greatly improve the success rate of acute severe pancreatitis.

关 键 词：ECMO 高脂血症 重症急性胰腺炎 重度ARDS 

分 类 号：R563[医药卫生—呼吸系统]