使用双腔导管实施静脉-静脉体外膜肺氧合治疗高处坠落多发伤致重度ARDS患儿1例  

A child suffering from severe acute respiratory distress syndrome due to multiple trauma was treated with veno-veous extracorporeal membrane oxygenation with the dual lumen cannula:a case report

作　　者：吴永然 惠越 陈伟 邹晓静[1] 郑翔 尚游[1] Wu Yongran;Hui Yue;Chen Wei;Zou Xiaojing;Zheng Xiang;Shang You(Department of Critical Care Medicine,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,Hubei,China;Department of Critical Care Medicine,Taihe Hospital,Hubei University of Medicine,Shiyan 442000,Hubei,China)

机构地区：[1]华中科技大学同济医学院附属协和医院重症医学科,武汉430022 [2]十堰市太和医院(湖北医药学院附属医院)重症医学科,十堰442000

出　　处：《中华危重病急救医学》2022年第10期1092-1094,共3页Chinese Critical Care Medicine

摘　　要：静脉-静脉体外膜肺氧合(VV-ECMO)用于治疗成人及儿童重度急性呼吸窘迫综合征(ARDS)已较为普遍,目前国内常规使用双部位单腔导管(即股静脉引流、颈内静脉回输的方式)实施成人和儿童ECMO。华中科技大学同济医学院附属协和医院重症医学科ECMO团队2021年12月16日在十堰市太和医院采用经颈内静脉置入双腔导管(DLC)行VV-ECMO成功抢救1例因高处坠落多发伤后意识障碍导致重度ARDS的患儿。患儿入院初步诊断为失血性休克、双侧血气胸、胸骨骨折、空腔器官穿孔、脾破裂、骨盆骨折后出现重度ARDS。在机械通气难以维持氧合的情况下,经右颈内静脉成功置入DLC后实施了VV-ECMO治疗,同时加强纤维支气管镜检查吸痰,并间断实施俯卧位治疗,给予抗感染、营养支持治疗,患儿氧合逐渐改善,11 d后成功撤离ECMO。本例患儿救治过程中,使用DLC简化了治疗流程,无任何相关并发症发生,提示DLC可安全有效地应用于儿童重度ARDS治疗。Veno-veous extracorporeal membrane oxygenation(VV-ECMO)has been widely used in the treatment for severe acute respiratory distress syndrome(ARDS).Up to now,the routine access to establish VV-ECMO involves two-sites single lumen cannula via femoral vein and internal jugular venous in adult and children,while few studies about the dual lumen cannula(DLC)in VV-ECMO implemented in adult and children have been reported.On December 16,2021,an unconscious child with severe ARDS due to multiple trauma caused by fatal falling from a height was admitted to Taihe Hospital.The initial diagnosis was hemorrhagic shock,bilateral hemopneumothorax,sternal fracture,cavity organ perforation,splenic rupture,and pelvic fracture and severe ARDS.Despite mechanical ventilation,he progressed to refractory hypoxemia and was treated with VV-ECMO after successful DLC placement in the right internal jugular vein by the mobile ECMO team of intensive care unit of the Union Hospital eventually.In addition,he received endoscopic sputum aspiration,prone position ventilation,anti-infection and nutritional treatment.His oxygenation gradually improved and he was successfully weaned from ECMO after 11 days.In this case,DLC simplified the process without any related complications,suggesting that it can be safely and effectively used in the treatment of Child's severe ARDS.

关 键 词：重度急性呼吸窘迫综合征 体外膜肺氧合 双腔导管 儿童 

分 类 号：R459.7[医药卫生—急诊医学] R725.6[医药卫生—治疗学]