体外膜氧合辅助9例危重型新型冠状病毒肺炎患者疗效分析  

Clinical analysis of COVID-19 patients supported by extracorporeal membrane oxygenation treatment

作　　者：高洁 李建朝[3] 程兆云[4] 秦秉玉 巩红岩[6] 芦乙滨 余旭 张保全[7] 钱晓亮[3] 杨雷一[3] 张静[5] 程剑剑 邵换璋 孟凡伟[3] 黑飞龙[9] Gao Jie;Li Jianchao;Cheng Zhaoyun;Qin Bingyu;Gong Hongyan;Lu Yibin;Yu Xu;Zhang Baoquan;Qian Xiaoliang;Yang Leiyi;Zhang Jing;Cheng Jianjian;Shao Huanzhang;Meng Fanwei;Hei Feilong(People's Hospital of Zhengzhou University,People's Hospital of Henan Province,Department of Anesthesia,Zhengzhou 450000,China;Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Department of Extracorporeal Circulation,Beijing 100037,China)

机构地区：[1]郑州大学人民医院,河南省人民医院麻醉科,郑州450000 [2]郑州大学人民医院,河南省人民医院重症医学科,郑州450000 [3]河南省人民医院,华中阜外医院,郑州大学华中阜外医院体外循环科,郑州450000 [4]河南省人民医院,华中阜外医院,郑州大学华中阜外医院心外科,郑州450000 [5]河南省人民医院,华中阜外医院,郑州大学华中阜外医院心脏重症监护室,郑州450000 [6]新乡医学院第一附属医院麻醉科,新乡453000 [7]新乡医学院第三附属医院重症医学科 [8]信阳市中心医院重症医学科,信阳464000 [9]中国医学科学院,北京协和医学院阜外医院体外循环中心,北京100037

出　　处：《中国体外循环杂志》2020年第4期203-207,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的总结体外膜肺氧合(ECMO)技术在新型冠状病毒肺炎(COVID-19)患者中的应用经验,并分析疗效。方法回顾性分析2020年1月1日至2020年5月1日本院与合作医院收治的9例接受ECMO治疗的危重型COVID-19患者的病历资料。对比9例患者治疗前与治疗24 h后的氧合指数(OI)、血管活性药物评分(VIS)、血乳酸值(LAC)、pH值、射血分数(EF)、并发症发生情况及转归。结果9例患者中男性6例,女性3例;年龄范围43~74岁;ECMO辅助前均诊断为危重型COVID-19。行静脉-静脉ECMO 6例,静脉-动脉ECMO 1例,静脉-动脉-静脉ECMO 2例。较辅助前相比,辅助24 h后氧合指数[(79.33±15.08)vs.(192.89±36.45)]、血管活性药物评分[(63.11±47.23)vs.(22.22±14.81)]、血乳酸值[(6.17±3.18)mmol/L vs.(2.67±1.09)mmol/L]均明显改善,差异有统计学意义(P<0.05)。9例患者均发生并发症,7例患者出现急性肾功能损伤,5例感染,5例肝功能损伤,4例出血,3例血栓形成。最终5例患者存活出院,4例死亡;存活患者需长期随访及康复治疗。结论危重型COVID-19患者使用ECMO辅助疗效显著,能挽救部分患者生命,但存在多种并发症风险。Objective To summarize the experience of extracorporeal membrane oxygenation(ECMO)treatment in patients with COVID-19,and to analyze its efficacy.Methods Retrospective analysis of the medical records of nine critically ill COVID-19 patients supported by ECMO in our hospital from January to May 2020 were made.The oxygenation indexs(OI),vasoactive-inotropic scores(VIS),blood lactic acid(LAC)levels,pH values,ejection fractions(EF%),complications and outcomes of the patients before and after treatment were compared.Results Among the 9 patients,there were 6 males and 3 females and their age ranged from 43 to 74 years.The patients were all diagnosed with critical COVID-19 before ECMO treatment.There were 6 cases of VV-ECMO,1 case of VA-ECMO,and 2 cases of VAV-ECMO.OI[(79.33±15.08)vs.(192.89±36.45)],VIS[(63.11±47.23)vs.(22.22±14.81)],LAC[(6.17±3.18)mmol/L vs.(2.67±1.09)mmol/L]were significantly better after 24 hours of ECMO treatment(P<0.05).All 9 patients had complications during the treatment,with 7 cases of acute renal failure,5 cases of infection,5 cases of liver failure,4 cases of bleeding,and 3 cases of thrombosis.Finally,5 patients survived and were discharged from the hospital with long-term follow-up and rehabilitation treatment required and 4 patients died.Conclusion ECMO in the treatment of critically ill COVID-19 patients showed significant clinical efficacy and might be effective in saving lives of some patients,but there are multiple risks of complications.

关 键 词：体外膜氧合 新型冠状病毒肺炎 急性呼吸窘迫综合征 临床疗效 

分 类 号：R563.1[医药卫生—呼吸系统]