体外膜肺氧合与呼吸机治疗重度肺爆震伤的疗效比较  

Efficacy comparison of extracorporeal membrane oxygenation and ventilation therapy in the treatment of severe blast lung injury

作　　者：陈检明 钟京 宋志明 陈松林 郭军华 余小平 蔡伟斌 窦燕 易云峰 Chen Jianming;Zhong Jing;Song Zhiming;Chen Songlin;Guo Junhua;Yu Xiaoping;Cai Weibin;Dou Yan;Yi Yunfeng(Department of Cardiothoracic Surgery,909th Hospital of Joint Logistics Support Force(Affiliated Dongnan Hospital of Xiamen University Medical College),Cardiothoracic Surgery Medical Center of Eastern War Zone,Zhangzhou363000,China)

机构地区：[1]联勤保障部队第九〇九医院(厦门大学医学院附属东南医院)心胸外科,东部战区心胸外科医学中心,漳州363000

出　　处：《中华创伤杂志》2022年第11期992-998,共7页Chinese Journal of Trauma

基　　金：全军后勤科研项目(CWH17J030,CNJ14C007);军队高层次科技创新人才工程人选自主科研项目(联战(2022)151)。

摘　　要：目的比较体外膜肺氧合(ECMO)与呼吸机治疗重度肺爆震伤的疗效。方法采用回顾性队列研究分析2000年1月至2021年12月联勤保障部队第九〇九医院(厦门大学医学院附属东南医院)收治的37例重度肺爆震伤患者临床资料,其中男23例,女14例;年龄26~50岁[(36.3±11.1)岁]。胸部简明损伤定级标准(AIS)为3~5分。2017年1月至2021年12月采用ECMO治疗16例(ECMO组)。2000年1月至2016年12月采用呼吸机治疗21例(呼吸机组)。比较两组治疗前30 min、治疗后2,4,6 h血气分析指标[动脉血pH值、二氧化碳分压(PaCO_(2))、氧分压(PaO2)、血乳酸(Lac)]、血流动力学指标[中心静脉压(CVP)、心排血指数(CI)、肺动脉收缩压(PASP)、肺毛细血管楔压(PAWP)],同时比较治疗后7 d机械通气时间、住ICU时间、急性生理学及慢性健康状况评估Ⅱ(APACHEⅡ)评分及病死率。结果患者均获随访24~48个月[(33.6±8.2)个月]。两组内治疗后2,4,6 h血气分析和血流动力学指标较治疗前30 min明显改善(P均<0.05),且ECMO组治疗后4,6 h较治疗后2 h仍持续改善(P均<0.05),而呼吸机组改善不明显(P均>0.05)。两组间治疗前30 min血气分析和血流动力学指标差异无统计学意义(P均>0.05),治疗后2,4,6 h差异有统计学意义(P均<0.05)。ECMO组治疗后7 d机械通气时间为(3.2±1.2)d,住ICU时间为(5.4±1.3)d,APACHEⅡ评分为(14.1±3.3)分,病死率为12.5%(2/16),与呼吸机组的(5.1±1.6)d、(7.6±1.6)d、(10.2±2.6)分、28.6%(6/21)比较,差异有统计学意义(P均<0.05)。结论对于重度肺爆震伤患者,与呼吸机治疗相比,ECMO治疗可快速和持续改善患者的顽固性低氧血症和呼吸困难,缩短机械通气时间和住ICU时间,降低病死率。Objective:To compare the clinical efficacy of extracorporeal membrane oxygenation(ECMO)and ventilation therapy in the treatment of severe blast lung injury.Methods:A retrospective cohort study was conducted to analyze the clinical data of 37 patients with severe blast lung injury admitted to 909th Hospital of Joint Logistics Support Force(Affiliated Dongnan Hospital of Xianmen University Medical College)from January 2000 to December 2021,including 23 males and 14 females;aged 26-50 years[(36.3±11.1)years].The chest abbreviated injury score(AIS)was 3-5 points.In all,16 patients were treated with ECMO from January 2017 to December 2021(ECMO group)and 21 with ventilator from January 2000 to December 2016(ventilator group).Blood gas analysis indexes[arterial pH,partial pressure of carbon dioxide(PaCO_(2)),partial pressure of oxygen(PaO_(2)),blood lactate(Lac)]and hemodynamics indexes[central venous pressure(CVP),cardiac output index(CI),pulmonary arterial systolic pressure(PASP),pulmonary capillary wedge pressure(PAWP)]were compared in the two groups at 30 minutes before treatment and at 2,4,6 hours after treatment.The mechanical ventilation time,ICU length of stay,acute physiology and chronic health evaluation II(APACHE II)score and mortality were measured at 7 days after treatment.Results:All patients were followed up for 24-48 months[(33.6±8.2)months].The blood gas analysis and hemodynamic indexes were significantly improved in the two groups at 2,4,6 hours after treatment when compared with those at 30 minutes before treatment(all P<0.05),and the improvements were still statistically significant in ECMO group at 4,6 hours after treatment when compared with those at 2 hours after treatment(all P<0.05),while not in ventilator group(all P>0.05).There was no significant difference in blood gas analysis indexes or hemodynamic indexes between the two groups at 30 minutes before treatment(all P>0.05).After treatment for 2,4,6 hours,blood gas analysis indexes and hemodynamic indexes in ECMO group were statistically dif

关 键 词：肺损伤 爆震伤 体外膜肺氧合 

分 类 号：R655.3[医药卫生—外科学]