肺移植患者术中体外膜氧合技术的应用  

Outcomes of extracorporeal membrane oxygenation during the lung transplantation

作　　者：陈官映 于芙民 林中林[1] 詹伟锋[2] 贲晓松[2] 舒海华 邓医宇[4] 周成斌[1] Chen Guanying;Yu Fumin;Lin Zhonglin;Zhan Weifeng;Ben Xiaosong;Shu Haihua;Deng Yiyu;Zhou Chengbin(Department of Perfusion,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Southern Medical University,Guangdong Guangzhou 510180,China)

机构地区：[1]广东省人民医院体外循环科,广州510180 [2]广东省人民医院胸外科,广州510180 [3]广东省人民医院麻醉科,广州510180 [4]广东省人民医院重症监护一科,广州510180

出　　处：《中国体外循环杂志》2024年第3期177-182,共6页Chinese Journal of Extracorporeal Circulation

基　　金：国家重点研发计划(2023YFC2507104)。

摘　　要：目的探讨体外膜氧合(ECMO)技术在肺移植患者术中应用的结局。方法回顾性分析2019年1月至2023年7月在单中心接受肺移植的44例患者,麻醉后肺移植前行ECMO 30例,术中未应用ECMO 14例。收集患者一般资料、血气分析结果和血流动力学指标,对比转流前后患者的肺动脉压变化情况,分析患者结局。结果ECMO可以减少患者术中二氧化碳潴留,术中肺动脉压显著下降(P<0.05)。肺移植手术完毕,术间撤离ECMO 6例,在ICU撤离24例,平均ECMO支持时间(33.65±49.68)h。术中未使用ECMO患者中有1例因术后低氧在ICU上ECMO,辅助281.95 h后因严重感染死亡。术中使用和未使用ECMO的两组患者术后24 h胸液量、ICU时间和住院死亡率没有显著差异。结论肺移植患者术中应用ECMO能够减轻二氧化碳潴留、降低肺动脉高压、不增加围术期出血量,且不影响预后。Objective To investigate the outcomes of extracorporeal membrane oxygenation(ECMO)in lung transplantation.Methods A total of 44 patients who underwent lung transplantation in a single center from January 2019 to July 2023 were retrospectively analyzed,including 30 cases with ECMO before lung transplantation after anesthesia and 14 cases without ECMO during the operation.The general data,blood gas analysis results and hemodynamics of the patients were collected.The changes of pulmonary artery pressure before and after bypass were compared,and the outcomes of patients were analyzed.Results ECMO could improve intraoperative carbon dioxide retention and decrease intraoperative pulmonary artery pressure(P<0.05).At the end of the operation,6 cases were weaned from ECMO during the operation,and 24 cases were weaned from ECMO in ICU,with an average ECMO support time of 33.65 hours.There was one patient who did not use ECMO due to secondary pulmonary malignant tumor.The patient developed postoperative hypoxia and was placed on ECMO in the ICU.After 281.95 hours of ECMO support,the patient unfortunately died of severe infection during the support period.There was no significant difference in the volume of pleural fluid in 24 hours after operation,the length of ICU stay and the in-hospital mortality between the two groups of patients with and without ECMO during operation.Conclusion The application of ECMO during lung transplantation can remove carbon dioxide retention,reduce pulmonary hypertension,and does not increase blood loss,but it does not affect the prognosis of patients.

关 键 词：肺移植 体外膜氧合 围术期 预后 肺动脉高压 

分 类 号：R655.3[医药卫生—外科学]