ECMO在肺移植麻醉中单中心的使用经验  

A single center experience of using ECMO in anesthesia for lung transplantation

作　　者：吴洋[1] 唐玲华[1] 詹丽英[2] 夏中元[1] WU Yang;TANG Linghua;ZHAN Liying;XIA Zhongyuan(Dept,of Anesthesiology,,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept,of Critical Care Medicine,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院麻醉科,湖北武汉430060 [2]武汉大学人民医院重症医学科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2021年第4期530-533,共4页Medical Journal of Wuhan University

摘　　要：目的:探讨肺移植麻醉过程中体外膜肺氧合(ECMO)的使用情况,总结肺移植术麻醉期间ECMO的使用经验。方法:回顾性分析2016年12月—2020年12月武汉大学人民医院19例肺移植患者,麻醉期间ECMO使用的临床资料。结果:19例患者中,诊断为慢性阻塞性肺疾病5例、特发性肺纤维化6例、支气管扩张2例、尘肺4例、Kartagener综合征l例、COVID-19晚期肺纤维化1例。共9例患者使用ECMO完成手术,麻醉前使用ECMO支持2例,7例患者在麻醉后使用ECMO,其中5例为静脉-静脉(V-V)ECMO,4例为静脉-动脉(V-A)ECMO。术中,1例更改为静脉-动脉-静脉(V-A-V)ECMO,1例使用了V-V和V-A双ECMO。术后4例撤除ECMO回监护室;5例保留ECMO回监护室,1例因多重感染无法脱离ECMO放弃治疗,其他均顺利撤除。10例患者未使用ECMO,术中发生心跳骤停1例。结论:ECMO是肺移植手术过程中重要的辅助工具,准确评估患者心肺功能并根据患者的氧合及循环状态使用ECMO,可以在肺移植麻醉期间为患者心肺功能提供有效的支持。Objective:To explore the use of extracorporeal membrane oxygenation(ECMO)during lung transplantation anesthesia, and summarize the experience.Methods:From December 2016 to December 2020, the clinical data of 19 patients with lung transplantation using ECMO during anesthesia in Renmin Hospital of Wuhan University were retrospectively analyzed.Results:Among the 19 patients, the main diagnosis were chronic obstructive pulmonary diseases in 5 cases, idiopathic pulmonary fibrosis in 6 cases, bronchiectasis in 2 cases, pneumoconiosis in 4 cases, Kartagener syndrome in1 case, and COVID-19 with advanced pulmonary fibrosis in 1 case.A total of 9 patients used ECMO to complete the operation.ECMO was used in 2 cases before anesthesia and 7 cases received ECMO treatment after anesthesia.Among them, 5 cases were veno-venous(V-V) ECMO and 4 cases were veno-arterial(V-A) ECMO.During operation, V-A ECMO was changed to veno-artery-vein(V-AV) ECMO in 1 case, another case used V-V plus V-A ECMO.After operation, 4 cases removed ECMO successfully and returned to the intensive care unit, and 5 cases took ECMO back to the intensive care unit.Among them, 4 cases removed ECMO successfully and 1 case failed due to multiple infections.Among the 10 patients who did not receive ECMO, 1 patient had cardiac arrest during the operation.Conclusion:ECMO is an important auxiliary tool in lung transplantation.Accurate evaluation of patients’ cardiopulmonary function and use of ECMO, according to their oxygenation and circulatory status, can provide effective support for lung transplantation anesthesia.

关 键 词：肺移植 麻醉 体外膜肺氧合 

分 类 号：R614.2[医药卫生—麻醉学]