ECMO救治多发伤合并创伤性湿肺急性二尖瓣脱垂的病例报道  

Case report of ECMO for multiple injury patient complicated with traumatic wet lung and mitral valve prolapse

作　　者：柳舟[1] 张亮[2] 夏文芳[1] 李光[1] 方小雨 李镇文 黄丽[3] 张旃[4] 詹丽英[1] LIU Zhou;ZHANG Liang;XIA Wenfang;LI Guang;FANG Xiaoyu;LI Zhenwen;HUANG Li;ZHANG Zhan;ZHAN Liying(Department of Intensive Care Unit,Renmin Hospital of Wuhan University,Wuhan,430060,China;Department of Radiology,Renmin Hospital of Wuhan University;Department of Gastroenterology,Renmin Hospital of Wuhan University;Department of Rehabilitation,Eastern Campus of Renmin Hospital of Wuhan University)

机构地区：[1]武汉大学人民医院重症医学科,武汉430060 [2]武汉大学人民医院放射科 [3]武汉大学人民医院消化内科 [4]武汉大学人民医院东院康复医学科

出　　处：《临床急诊杂志》2023年第11期597-603,共7页Journal of Clinical Emergency

摘　　要：本文报道1例30岁男性患者,因“高坠伤18 h”入院。紧急至当地医院头胸腹CT提示全身多处骨折伴脾挫裂伤、骨盆出血,积极输血止血、补液复苏后,紧急行骨盆外固定、左下肢牵引及双髂动脉/脾动脉部分栓塞术。术后患者氧合不能维持,血压持续下降,遂转诊至我院,急诊以“多发伤”收入我科。患者严重创伤性湿肺、多处肋骨、胸骨骨折合并大量胸腔积液,胸腔闭式引流术后紧急行纤支镜术,反复调整呼吸机参数仍表现为难治性低氧血症。患者氧合差,心率快,血压低且乳酸进行性升高,评估后紧急VV-ECMO辅助。ECMO后患者循环仍不稳定,心脏彩超提示二尖瓣脱垂伴重度返流,择期行二尖瓣置换术联合肋骨、胸骨骨折内固定术。术后患者病情逐渐平稳,气管切开术后过度清醒ECMO,顺利撤机。A 30-year-old male patient was admitted to hospital for high fall injury within 18 hours.The patient was then transferred to local hospital,CT examination of head,chest and abdomen revealed multiple fractures.After fluid resuscitation and blood transfusion,the local hospital considered pelvic and spleen hemorrhage,thus external pelvic fixation,left lower limb traction,embolization of iliac arteries and splenic were performed.However,the patient condition still deteriorated,oxygenation could not maintain and blood pressure continued to drop sharply,so he was transferred to emergency department and admitted to ICU.The patient suffered from severe traumatic wet lung,multiple rib fractures,sternal fractures complicated with pleural effusion,so closed thoracic drainage and emergency bronchoscopy were immediately performed.Although repeated adjustment ventilator parameters,patient still presented refractory hypoxemia,rapid heart rate,low blood pressure and progressive elevation of lactic.Emergency VV-ECMO was preformed after comprehensive consideration,however the circulation still remained unstable.At critical time,ultrasound verified mitral valve prolapse combined with severe mitral regurgitation.Thus,mitral valve replacement combined with internal rib and sternum facture fixation elective surgeries were planned.The patient condition gradually stabilized after operation,tracheotomy was successfully conducted,awake ECMO was finally performed and then smoothly withdrawn.

关 键 词：体外膜肺氧合 创伤性湿肺 急性呼吸窘迫综合征 二尖瓣反流 二尖瓣置换术 多发伤 

分 类 号：R541.4[医药卫生—心血管疾病]