VV-ECMO救治重度ARDS患者并发右心功能不全的管理  

Management of right ventricular disfunction in severe acute respiratory distress syndrome patients supported with veno-venous extracorporeal membrane oxygenation

作　　者：刘学松[1] 张容[1] 席寅[1] 陈思蓓[1] 刘晓青[1] 黎毅敏[1] Liu Xuesong;Zhang Rong;Xi Yin;Chen Sibei;Liu Xiaoqing;Li Yimin(Department of Critical Care Medicine,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou Institute of Respiratory Disease,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院重症医学科广州呼吸健康研究院,510120

出　　处：《国际呼吸杂志》2020年第12期904-910,共7页International Journal of Respiration

基　　金：国家科技重大专项(2017ZX10204401)。

摘　　要：目的探讨如何识别和管理急性呼吸窘迫综合征(ARDS)患者并发的右心功能不全。方法广州医科大学附属第一医院收入1例重度ARDS患者,期间并发右心功能不全,积极给予综合处理。结果经过液体的优化(包括输注的总量与速度)、感染控制、气道的引流、改善胸腹腔压力、心率控制、药物降肺动脉压、右心保护的肺通气策略和体外膜肺氧合支持等右心管理的措施,患者右心功能逐步恢复。结论以右心保护为核心的循环管理是ARDS治疗的关键环节之一。Objective To explore how to identify and manage the right ventricular dysfunction in severe acute respiratory distress syndrome(ARDS)patients.Methods A patient with severe ARDS was admitted to the First Affiliated Hospital of Guangzhou Medical University.During this period,he was complicated with right heart dystunction and was given comprehensive treatment.Results After optimization of fluids(including total volume and speed of infusion),infection control,airway drainage,improved thorax and abdominal cavity pressure,heart rate control,medication to lower pulmonary artery pressure,right ventricle protection lung ventilation strategy,extracorporeal membrane oxygenation support and other right heart management,the patient′s right heart function gradually recovered.Conclusions Circulation management with right heart protection as the core is one of the keys in the management of ARDS.

关 键 词：呼吸窘迫综合征 成人 右心功能不全 体外膜氧合作用 连续性肾脏替代治疗 

分 类 号：R563.8[医药卫生—呼吸系统] R544.1[医药卫生—内科学]