体外膜肺氧合在肺移植围术期的应用探讨  

Application of extracorporeal membrane oxygenation in the perioperative period of lung transplantation

作　　者：马承泰 白镓玮 吴淼[2] 杜贤进[1] MA Chengtai;BAI Jiawei;WU Miao;DU Xianjin(Dept,of Critical Care Medicine,Wuhan 430060,Hubei,China;Dept,of Emergency,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

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

出　　处：《武汉大学学报（医学版）》2021年第4期558-563,共6页Medical Journal of Wuhan University

基　　金：中央高校基本科研业务费专项资金青年教师资助项目(编号:2042020kf0109);北京协和医学基金会-睿E(意)急诊医学专项研究基金(编号:R2019028)。

摘　　要：目的:探讨体外膜肺氧合(ECMO)在肺移植围术期的使用情况,总结肺移植围术期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例接受肺移植手术患者的临床资料,根据是否使用ECMO支持将患者进行分组比较。结果:19例患者中,慢性阻塞性肺疾病5例,支气管扩张3例,尘肺4例,特发性肺纤维化4例,结缔组织病肺间质纤维化1例,Kartagener综合征1例、新型冠状病毒肺炎晚期肺纤维化1例。其中非ECMO组患者10例,1例术中死亡,1例术后放弃治疗死亡,1例放弃治疗出院。ECMO组患者9例,2例患者术前使用ECMO桥接治疗,其余7例在麻醉后使用ECMO辅助治疗,ECMO组中死亡1例,放弃治疗出院1例,其余患者均成功撤除ECMO后好转出院。两组患者仅在术前呼吸支持方式上存在差异(P=0.033),在性别、年龄、术前评估结果、手术过程、住院时间、住ICU时间、术后多重耐药菌感染及结局上并无明显差异。结论:ECMO是肺移植围术期的重要辅助工具,使用ECMO既不会额外增加患者术后感染多重耐药菌的概率,也不会导致死亡率的升高,而患者术前呼吸支持方式的选择对围术期患者是否使用ECMO存在参考价值。Objective:To investigate the application of extracorporeal membrane oxygenation(ECMO) in the perioperative period of lung transplantation, and summarize the experience.Methods:The clinical data of 19 patients receiving lung transplantation operation in Renmin Hospital of Wuhan University from December 2016 to December 2020 were retrospectively analyzed.Patients were divided into groups according to whether ECMO support was used, and their clinical data were compared.Results:Among the 19 patients, there were 5 cases of chronic obstructive pulmonary disease, 3 cases of bronchiectasis, 4 cases of pneumoconiosis, 4 cases of idiopathic pulmonary fibrosis, 1 case of connective tissue disease interstitial pulmonary fibrosis, 1 case of Kartagener syndrome, and 1 case of COVID-19 with advanced pulmonary fibrosis.Among the 10 patients in the non-ECMO group, 1 died during the operation, 1 died after abandoning treatment, and 1 was discharged after abandoning treatment.There were 9 patients in the ECMO group, 2 patients received ECMO bridged treatment before surgery, and the remaining 7 patients received ECMO adjuvant treatment after anesthesia.In the ECMO group, 1 patient died, 1 patient was discharged after abandoning treatment, and the rest patients were all improved and discharged after successful weaning of ECMO.The two groups only differed in the way of preoperative respiratory support(P=0.033).There were no significant differences in gender, age, preoperative assessment, surgical process, length of hospital stay, ICU stay, postoperative multi-drug resistant organism infection, and outcome.Conclusion:ECMO is an important auxiliary tool during the perioperative period of lung transplantation.The use of ECMO did not increase the risk of postoperative infection with multidrug-resistant bacteria, nor did it lead to an increase in mortality.In the other hand, the choice of preoperative respiratory support method has reference for perioperative patients whether to use ECMO.

关 键 词：肺移植 体外膜肺氧合 围术期 

分 类 号：R617[医药卫生—外科学]