ECMO支持下成功救治成人重症胸外伤1例  

Successful treatment of an adult with severe chest trauma under extracorporeal membrane oxygenation: a case report

作　　者：田仁斌 陈松 宋扬 Tian Renbin;Chen Song;Song Yang(Department of Cardiovascular Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi 563000,Guizhou,China;Department of Anesthesiology,Affiliated Hospital of Zunyi Medical University,Zunyi 563000,Guizhou,China)

机构地区：[1]遵义医科大学附属医院心血管外科,贵州遵义563000 [2]遵义医科大学附属医院麻醉科,贵州遵义563000

出　　处：《中华危重病急救医学》2021年第10期1257-1259,共3页Chinese Critical Care Medicine

基　　金：贵州省遵义市科技计划项目(2019-110)。

摘　　要：静脉-静脉体外膜肺氧合(VV-ECMO)对于胸部创伤患者和一些需要手术的患者是一种有价值的治疗选择。遵义医科大学附属医院2020年2月27日收治1例外院转入的35岁女性重症胸外伤患者,患者因高处坠落致胸部疼痛伴呼吸困难入院,急诊胸部CT显示:右侧液气胸(右肺压缩约60%),左侧胸腔积液、积血,心包少量积液,下颈部、胸背部、纵隔多发气肿,有创呼吸机难以维持通气。经过评估后实施VV-ECMO,并给予开胸手术。术中见气管破裂约1.2 cm,进行气管修复手术。手术在VV-ECMO持续支持下历时4 h。术后给予患者机械通气,经评估,患者血流动力学稳定、氧供充足,故顺利撤除ECMO。经过16 d的治疗,患者胸部CT显示:与入院时比较,胸壁皮下气肿减少,双肺渗出性病变减少,提示患者治疗有效,达到出院标准,无任何并发症。在本例患者救治过程中,VV-ECMO应用迅速,持续时间短,为患者提供了急诊手术的机会,最终使患者完全康复。因此,VV-ECMO可为严重创伤和难治性低氧血症患者提供支持。Veno-venous extracorporeal membrane oxygenation(VV-ECMO)is a valuable treatment option for chest trauma individuals and some patients required surgery.A 35-year-old female patient with severe chest trauma was admitted to Affiliated Hospital of Zunyi Medical University on February 27,2020.The patient was hospitalized with chest pain and dyspnea due to fall from a height.Emergency chest CT revealed a right fluid pneumothorax(60%of right lung compression),left hemothorax,little pericardial effusion,and multiple emphysemas in the lower neck,chest,back and mediastinum.Invasive ventilator was difficult to maintain oxygen saturation.After evaluation,the VV-ECMO was established,then,she received a thoracotomy.There was a 1.2 cm trachea rupture observed during operation,and the trachea was repaired.The operation lasted 4 hours with the continuous support of VV-ECMO.When the patient's haemodynamics and oxygenation was stable,ECMO was removed.Sixteen days later,the patient's chest CT showed that,the chest wall subcutaneous emphysema was reduced,and the exudative lesions of both lungs were absorbed,indicating that the patient was treated effectively and reached the discharge standard with no complication.During the treatment of this patient,VV-ECMO was applied rapidly and lasted for a short period,which provided the patient with the opportunity of emergency operation and finally the patient was fully recovered.VV-ECMO can provide support for patients with severe trauma and refractory hypoxemia.

关 键 词：胸部创伤 体外膜肺氧合 氧合作用 支气管破裂 

分 类 号：R655[医药卫生—外科学]